Vitamin D status predicts new brain MRI activity in multiple sclerosis
Ellen M. Mowry M.D., M.C.R1,†,‡, emowry1 at jhmi.edu
Emmanuelle Waubant M.D., Ph.D1,‡,
Charles E. McCulloch Ph.D2,‡,
Darin T. Okuda M.D3,‡,
Alan A. Evangelista1,‡,
Robin R. Lincoln B.S1,‡,
Pierre-Antoine Gourraud Ph.D1,‡,
Don Brenneman B.A1,‡,
Mary C. Owen N.P1,‡,
Pamela Qualley M.A1,‡,
Monica Bucci M.D4,5,‡,
Stephen L. Hauser M.D1,‡,
Daniel Pelletier M.D1,6,‡,*
1 MS Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
2 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
3 Department of Neurology, Barrow Neurological Institute, Phoenix, AZ
4 Department of Radiology, University of California, San Francisco
5 Department of Neurology, Istituto Neurologico C. Besta, Milan, Italy
6 Department of Neurology, Yale University, New Haven, CT
† Ph (410) 502-0675; Fax (410) 502-6736
‡ Authors' contributions: conception and design (EMM, EW, SLH, DP); acquisition of data (EMM, DTO, AE, RL, PG, DB, MO, PQ, MB, DP); analysis and interpretation of data (EMM, EW, CM, PG, DP); drafting of the manuscript (EMM, DP); critical revision of the manuscript (all authors); statistical analysis (EMM, CM); obtaining funding (EMM, DP, SLH); supervision (RL, PQ, DP).
Annals of Neurology Vol. 71 Issue 2
Objective: We sought to determine if vitamin D status is associated with developing new T2 lesions or contrast-enhancing lesions on brain MRI in relapsing multiple sclerosis (MS).
Methods: EPIC is a five-year longitudinal MS cohort study at the University of California, San Francisco. Participants had clinical evaluations, brain MRI, and blood draws annually. From the overall cohort, we evaluated patients with clinically isolated syndrome or relapsing-remitting MS at baseline. In univariate and multivariate (adjusted for age, sex, ethnicity, smoking, and MS treatments) repeated measures analyses, annual 25-hydroxyvitamin D levels were evaluated for their association with subsequent new T2-weighted and gadolinium-enhancing T1-weighted lesions on brain MRI, clinical relapses, and disability (Expanded Disability Status Scale [EDSS]).
Results: 2,362 3T brain MRI scans were acquired from 469 subjects.
In multivariate analyses, each 10 ng/mL higher 25-hydroxyvitamin D was associated with a 15% lower risk of a new T2 lesion (incidence rate ratio [IRR]= 0.85, 95% CI [0.76, 0.95], p=0.004) and a 32% lower risk of a gadolinium-enhancing lesion (IRR=0.68, 95% CI [0.53, 0.87], p=0.002).
Each 10 ng/mL higher vitamin D level was associated with lower subsequent disability (-0.047, 95% CI [-0.091, -0.003], p=0.037).
Higher vitamin D levels were associated with lower, but not statistically significant, relapse risk.
Except for the EDSS model, all associations were stronger when the within-person change in vitamin D level was the predictor.
Interpretation: Vitamin D levels are inversely associated with MS activity on brain MRI.
These results provide further support for a randomized trial of vitamin D supplementation.
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