A pilot-randomized, double-blind crossover trial to evaluate the pharmacokinetics of orally administered 25-hydroxyvitamin D3 and vitamin D3 in healthy adults with differing BMI and in adults with intestinal malabsorption

Abstract

Background Obese and malabsorptive patients have difficulty increasing serum 25-hydroxyvitamin D [25(OH)D] after taking vitamin D supplementation. Since 25(OH)D is more hydrophilic than vitamin D, we hypothesized that oral 25(OH)D supplementation is more effective in increasing serum 25(OH)D concentrations in these patients. Objectives We aimed to investigate the pharmacokinetics of oral 25-hydroxyvitamin D3 [25(OH)D3] and oral vitamin D3 in healthy participants with differing BMI and malabsorptive patients. Methods A randomized, double-blind crossover trial was performed in 6 malabsorptive patients and 10 healthy participants who were given 900 µg of either vitamin D3 or 25(OH)D3 orally followed by a pharmacokinetic study (PKS). After ≥28 d from the first dosing, each participant returned to receive the other form of vitamin D and undergo another PKS. For each PKS, serum vitamin D3 and 25(OH)D3 were measured at baseline and at 2, 4, 6, 8, and 12 h and days 1, 2, 3, 7, and 14. Pharmacokinetic parameters were calculated. Results Data were expressed as means ± SEMs. The PKS of 900 µg vitamin D3 revealed that malabsorptive patients had 64% lower AUC than healthy participants (1177 ± 425 vs. 3258 ± 496 ng · h/mL; P < 0.05). AUCs of 900 µg 25(OH)D3 were not significantly different between the 2 groups (P = 0.540). The 10 healthy participants were ranked by BMI and categorized into higher/lower BMI groups (5/group). The PKS of 900 µg vitamin D3 showed that the higher BMI group had 53% lower AUC than the lower BMI group (2089 ± 490 vs. 4427 ± 313 ng · h/mL; P < 0.05), whereas AUCs of 900 µg 25(OH)D3 were not significantly different between the 2 groups (P = 0.500). Conclusions Oral 25(OH)D3 may be a good choice for managing vitamin D deficiency in malabsorption and obesity. This trial was registered at clinicaltrials.gov as (NCT03401541.

Real world evidence of calcifediol or vitamin D prescription and mortality rate of COVID-19 in a retrospective cohort of hospitalized Andalusian patients

“…In fact, calcifediol may have some advantages over native vitamin D3. Thus, the former has a more reliable intestinal absorption (close to 100%) and can more rapidly restore serum concentrations of 25OHD as it does not require hepatic 25-hydroxylation 33 , 51 . In fact, calcifediol is three times more potent than oral cholecalciferol in raising serum 25OHD levels 52 .…”

Vitamin D3 is well correlated with anti-Helicobacter pylori immunoglobulins and could be a well biomarker for immunity competence against the disease

“…Vit.D3 malabsorption from the gastrointestinal route results in its low serum level and reduced innate and acquired immunity responses. [ 33 ] Therefore, it is supposed that the Igs related to the early stage of the disease, i.e., IgM and the IgA, may not be sufficiently produced. Anyhow, the demonstration of Vit.D3's effects on the physiology and pathology of the diseases is not simple because of the pathways’ complexities.…”

Vitamin D Endocrine System and COVID-19: Treatment with Calcifediol

“…CYP2R1 mutations are rare in the general population, and it seems that only bi-allelic mutations create problems in producing sufficient 25OHD [91]. The functional impairment of CYP2R1 activity, however, has been well demonstrated in several animal models of obesity, diabetes, or glucocorticoid excess [92] and is likely in patients with obesity or type 2 diabetes, with malabsorption [93] or with inflammatory lung diseases, such as COPD or asthma [94,95]. Thus, treatment with calcifediol is more effective than cholecalciferol in increasing serum 25OHD concentrations in these patients.…”