School of Medicine, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia.
Department of Neurology, Gold Coast University, Hospital, Southport, QLD, Australia.
J Neurol. 2018 Dec;265(12):2893-2905. doi: 10.1007/s00415-018-9074-6. Epub 2018 Oct 3.
There is an association between latitude, relative vitamin D deficiency and risk of multiple sclerosis (MS), and an association between vitamin D and disease progression. We have performed a meta-analysis with the aim of investigating the role of therapeutic vitamin D in MS.
A systematic search of databases was performed to identify clinical trials assessing vitamin D in patients with relapsing-remitting MS. Studies were selected based on inclusion and exclusion criteria. Analysis was performed using RevMan 5.3 software.
Twelve studies involving 950 patients were included in the final analysis. Studies were divided into four groups because of heterogeneity in study design. Studies were judged to be at low or unclear risk of bias, except in three studies, and this was confirmed by funnel plots. No statistically significant difference was seen for any of the outcome measures. There were non-significant trends in favour of vitamin D for all outcome measures, particularly when only placebo-controlled studies were included. Dose comparison studies showed a significant increase in annualised relapse rate (mean difference 0.15 [95%CI 0.01-0.30]) and non-significant trends of increased Expanded Disability Status Scale and gadolinium-enhancing lesions for the higher-dose arms.
These findings suggest that vitamin D supplementation may have a therapeutic role in the treatment of MS. However, there is uncertainty with regard to the most appropriate dose, with high doses potentially being associated with worse outcomes. There remains the need for further well-performed randomised, dose-ranging, placebo-controlled trials of vitamin D in MS.
纬度、相对维生素 D 缺乏与多发性硬化症（MS）风险之间存在关联，维生素 D 与疾病进展之间也存在关联。我们进行了一项荟萃分析，旨在研究治疗性维生素 D 在 MS 中的作用。
系统检索数据库以确定评估维生素 D 在复发性缓解型 MS 患者中的临床试验。根据纳入和排除标准选择研究。使用 RevMan 5.3 软件进行分析。
最终分析纳入了 12 项涉及 950 名患者的研究。由于研究设计存在异质性，研究分为四组。除了三项研究外，所有研究均被判断为低风险或不确定风险，这也得到了漏斗图的证实。对于任何结局指标均未观察到统计学差异。对于所有结局指标，均显示维生素 D 有非显著趋势有利，尤其是当仅纳入安慰剂对照研究时。剂量比较研究显示，年复发率显著增加（平均差异 0.15 [95%CI 0.01-0.30]），高剂量组扩展残疾状况量表和钆增强病变有非显著趋势增加。
这些发现表明，维生素 D 补充可能在 MS 的治疗中具有治疗作用。然而，对于最合适的剂量存在不确定性，高剂量可能与更差的结局相关。仍需要进一步开展良好设计的、剂量范围的、安慰剂对照的维生素 D 在 MS 中的随机试验。
