Effects of vitamin D supplementation on the outcomes of patients with pulmonary tuberculosis: a systematic review and meta-analysis

Abstract

BackgroundVitamin D is involved in the host immune response toward Mycobacterium tuberculosis. However, the efficacy of vitamin D supplementation on sputum conversion, clinical response to treatment, adverse events, and mortality in patients with pulmonary tuberculosis (PTB) remains controversial. We aimed to clarify the efficacy and safety of vitamin D supplementation in PTB treatment.MethodsWe searched Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science for double-blind, randomized controlled trials of vitamin D supplementation in patients with PTB that reported sputum conversion, clinical response to treatment, adverse events, or mortality, published from database inception to November 26, 2017. This study was registered with PROSPERO, number CRD42018081236.ResultsA total of 1787 patients with active PTB receiving vitamin D supplementation along with standard anti-tuberculosis regimen were included in the eight trials with different doses of vitamin D ranging from 1000 IU/day to 600,000 IU/month at different intervals. Primary analysis revealed that vitamin D supplementation increased the proportion of sputum smear and culture conversions (OR 1.21, 95%CI 1.05~ 1.39, z = 2.69, P = 0.007; OR 1.22, 95%CI 1.04~ 1.43, z = 2.41, P = 0.02), but did not improve the time to sputum smear and culture conversions (HR 1.07, 95%CI 0.83~ 1.37, z = 0.50, P = 0.62; HR 0.97, 95%CI 0.76~ 1.23, z = 0.29, P = 0.77). In the secondary analysis, vitamin D improved serum 25(OH)D, plasma calcium concentration, lymphocyte count, and chest radiograph (MD 103.36, 95%CI 84.20~ 122.53, z = 10.57, P < 0.00001; SMD 0.26, 95%CI 0.15~ 0.37, z = 4.61, P < 0.00001; MD 0.09, 95%CI 0.03~ 0.14, z = 2.94, P = 0.003); MD -0.33, 95% CI -0.57~ − 0.08 z = 2.57, P = 0.01), but had no impact on adverse events, mortality and other indicators(TB score, BMI, mean mid-upper arm circumference, weight gain, CRP, ESR, and other blood cells) (P > 0.05).ConclusionsVitamin D supplementation can be considered as a combination therapy in patients with PTB.Electronic supplementary materialThe online version of this article (10.1186/s12890-018-0677-6) contains supplementary material, which is available to authorized users.

Evidence-based management of COVID-19 in cancer patients: Guideline by the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO)

“… 75 However, in other infectious diseases, supplementation has been shown to be beneficial. 76 Thus, we marginally support appropriate vitamin D supplementation (CIII). For other nutrients such as iron, selenium or vitamin C no conclusive data support supplementation with regard to COVID-19.…”

Vitamin D Deficiency Picture: An Indian laboratory Retrospective Study of Over 10,000 Subjects

“…This study involving 1787 patients involved in active vitamin D supplementation with the standard anti-tuberculosis regimen detected increase in proportion of sputum smear and culture conversion and also improvement in plasma calcium, lymphocyte count and chest radiograph was noted. [25] Recent global reports also indicate vitamin D market to touch $2.5 billion by the year 2020 and the Assocham Healthcare Committee revealed 8 in 10 people from Delhi region of the country to be affected by VDD. [26] CONCLUSION The need for aggressive screening and monitored supplementation and treatment strategies are a necessity to tackle the global malady of vitamin D deficiency.…”

Infections and diabetes: Risks and mitigation with reference to India

“…In patients with risk of limb ischemia and/or hypoalbuminemia, supplementation with arginine, glutamine and betahydroxy methyl butyrate has been shown to improve foot ulcer healing [ 53 ]. Supplementation of vitamin D has been shown to improve the proportion of sputum smear and culture conversion in patients with active pulmonary TB (with or without diabetes) [ 54 ]. Similarly, vitamin D deficiency was associated with an increased risk of testing positive for COVID-19, raising the possibility that supplementation of this vitamin could reduce the risk of COVID infection; however, it should be noted that this study was not restricted to individuals with diabetes [ 55 ].…”

“…Supplementation of vitamin D has been shown to improve the proportion of sputum smear and culture conversion in patients with active pulmonary TB (with or without diabetes) [ 54 ].…”