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Vitamin D Supplementation and its Effect on Relapse Frequency and MRI Activity in Adults With Multiple Sclerosis: A
Kamren Hall1, Jessica Renteria1, Elizabeth Fernandez1
1Kansas College of Osteopathic Medicine, Wichita, Kansas, USA.
Introduction:
Literature evidence links vitamin D supplementation to clinical outcomes in multiple sclerosis (MS), yet no systematic review has focused specifically on relapse rate and MRI activity. Thus, this systematic review aimed to evaluate the effect of vitamin D supplementation on relapse rate and magnetic resonance imaging (MRI) disease activity in adults with clinically diagnosed MS.
Methods:
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed, Cochrane, EBSCO, and Web of Science were searched for studies discussing vitamin D supplementation in adults with diagnosed MS. Annualized relapse rate (ARR) and changes in MRI activity were the primary outcome measures. Non-randomized studies and randomized controlled trials were assessed for their risk of bias using the Cochrane ROBINS-I and RoB-2 tools, respectively.
Results:
Of 304 records identified, 127 duplicates were removed and 177 were screened, with 11 primary studies (14 reports) included after full-text review. Across studies, vitamin D supplementation did not suggest a reduced ARR with most randomized trials reporting no significant difference between groups. One trial using alfacalcidol provides evidence for a reduction in relapse risk, but this was not replicated. MRI outcomes were more variable, with several studies showing reductions in inflammatory lesion activity, while others found no significant effect. Overall, results were inconsistent, and due to heterogeneity in study design and reporting, findings were synthesized narratively without meta-analysis.
Conclusion:
Vitamin D supplementation does not consistently reduce relapse rates in adults with MS, although some studies report improvement in MRI activity. The overall certainty of evidence is limited by variation in study design, patient population, cohort size, and risk of bias. Current data does not support vitamin D as a disease-modifying therapy beyond correction of deficiency; further, larger, standardized trials are needed to clarify its clinical role.
Insights
Vitamin D supplementation does not consistently reduce relapse rates in multiple sclerosis (MS). While some studies show improved MRI activity, evidence is limited, and more research is needed to clarify its role.
Area of Science:
- Neurology
- Immunology
- Nutritional Science
Background:
- Vitamin D supplementation is linked to clinical outcomes in multiple sclerosis (MS).
- Previous systematic reviews have not specifically focused on relapse rate and MRI activity in MS patients.
- Existing literature suggests a potential, yet unconfirmed, benefit of vitamin D in managing MS.
Purpose of the Study:
- To systematically review the effect of vitamin D supplementation on relapse rate and MRI disease activity in adults with MS.
- To evaluate the consistency and certainty of evidence regarding vitamin D's impact on MS progression markers.
- To identify gaps in current research and guide future clinical trials.
Main Methods:
- Systematic review conducted following PRISMA guidelines.
- Searched PubMed, Cochrane, EBSCO, and Web of Science for relevant studies.
- Assessed risk of bias using Cochrane ROBINS-I and RoB-2 tools for non-randomized and randomized trials, respectively.
- Primary outcomes included annualized relapse rate (ARR) and changes in MRI activity.
Main Results:
- 11 primary studies (14 reports) were included after screening 304 records.
- Vitamin D supplementation did not consistently reduce ARR; most randomized trials showed no significant difference.
- MRI outcomes were variable, with some studies reporting reduced inflammatory lesion activity, while others found no significant effect.
- Findings were synthesized narratively due to heterogeneity in study design and reporting.
Conclusions:
- Vitamin D supplementation does not consistently reduce relapse rates in adults with MS.
- Some studies indicate potential improvements in MRI activity, but overall evidence certainty is limited.
- Current data does not support vitamin D as a disease-modifying therapy beyond correcting deficiency; larger, standardized trials are necessary.
