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06-11-2017 | Rheumatology | News | Article

Vitamin D supplementation may benefit SLE patients

medwireNews: Low vitamin D levels are associated with a high risk for end-stage renal disease, thrombosis, and elevated cholesterol in patients with systemic lupus erythematosus (SLE), pointing to multiple benefits of supplementation, findings indicate.

The three posters were presented at the 2017 ACR/ARHP Annual Meeting in San Diego, California, USA by Michelle Petri (Johns Hopkins University School of Medicine, Baltimore, Maryland, USA), who told medwireNews that she hopes that the data will be “transforming because vitamin D is so safe for patients.”

Using data from the Hopkins Lupus Cohort, the researchers found that the relative risk for end-stage renal disease after adjustment for age, sex, and ethnicity was a significant 1.66 times higher for the 27.3% of 1392 patients with 25-hydroxyvitamin D (25[OH]D) levels below 20 ng/mL at baseline than for their counterparts with levels above the cutoff.

Petri said that these findings could have major implications as mycophenolate, which is currently the best option for SLE patients who develop renal disease, only induces renal remission in 50% of patients. “If very safe medications like vitamin D can help then that is really going to change how we think about treating lupus nephritis,” she commented.

The team also investigated the association between vitamin D and thrombosis, finding that vitamin D insufficiency, defined as 25(OH)D levels of less than 40 ng/mL, was linked to a significant 2.31-fold increased risk for deep vein thrombosis after accounting for age, sex, ethnicity, and the presence of lupus anticoagulant antibodies.

Furthermore, when participants with a history of thrombotic events prior to vitamin D measurement were excluded, low levels were also significantly associated with the risk for any thrombosis, with an adjusted hazard ratio of 1.75.

Finally, among 1358 patients drawn from the same cohort, the researchers observed a significant association between 25(OH)D levels under 50 ng/mL and higher average cholesterol levels. And as vitamin D levels rose in response to supplementation (in most cases 50,000 IU/week), they noted a corresponding decrease in total cholesterol.

Petri summarized that “one treatment can help to address multiple issues,” but as vitamins are not covered by health insurance, patients will need to pay out of their own pocket.

Unfortunately, patients with lupus cannot top up their vitamin D levels in “the cheap way by going to the beach” because sun exposure can provoke disease flares and these patients also have an increased malignancy risk, she added.

By Shreeya Nanda

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