<p>Vitamin D supplementation for the prevention or depletion of side effects of therapy with alemtuzumab in multiple sclerosis</p>

Abstract

Purpose of review: Not only the multiple sclerosis specialist but also the general neurologist and primary care practitioner are increasingly aware of possible adverse events (AEs) by treatment with alemtuzumab (over 47% risk of secondary autoimmune-mediated diseases). Vitamin D supplementation's effect (VDS) to reduce these autoimmune AEs is poorly performed in routine practice. This article seeks to justify why this simple, inexpensive, patient-friendly therapy should be seriously discussed. Recent findings: Patients who have developed autoimmunity also show a high basal level of IL-21, a cytokine which increases the growth of auto-reactive T-cells. For side effects such as thyroid dysfunction, autoimmune thrombocytopenia, autoimmune hemolytic anemia, autoimmune hepatitis, diabetes mellitus type 1, and alopecia areata/alopecia totalis, VDS may have an impact on the immunological mechanism, in particular lowering levels of IL-17 and IL-21. Summary: The potential role of vitamin D in influencing autoimmune diseases is evident. If a life-threatening side-effect can be prevented by high-dose VDS, it is ethical to initiate this add-on therapy despite contradictory results in studies on the effectiveness of VDS.

Low vitamin D levels do not predict risk of autoimmune disease following alemtuzumab treatment for multiple sclerosis

“…This is counter to a recently postulated hypothesis. (Goischke, 2019) We have shown that the risk of autoimmune disease following alemtuzumab is higher for women (HR 3.6). This risk factor has been noted previously.…”

“…(Li et al, 2016) As noted above relative vitamin D deficiency is a risk factor for MS and this has also been noted for a number of other autoimmune diseases (see Table 1). (Xu et al, 2015;Lee and Bae, 2016;Islam et al, 2019;Feng et al, 2015;Penna-Martinez et al, 2018;Klack and Carvalho, 2010;Antico et al, 2012;Orgaz-Molina et al, 2012) This has led some to speculate that vitamin D deficiency might be a potentially modifiable factor in the development of autoimmune disease following alemtuzumab for MS. (Goischke, 2019) We have undertaken a retrospective case-control study of vitamin D levels in a cohort of people with MS treated with alemtuzumab with the aim of identifying factors associated with an increased risk of autoimmune disease. The primary hypothesis being tested is that the occurrence of autoimmune disease following alemtuzumab therapy will be associated with lower levels of vitamin D in the peri-and post-treatment phase.…”

Alopecia Universalis Occurring after Alemtuzumab Treatment for Multiple Sclerosis. A Two-Year Follow-Up of Two Patients

“…This is related to the well-known effects of VD, both on the hair follicle and on the immune system. In particular, VD levels are negatively associated with IL-21 and IL-17 concentrations [ 13 ]. In turn, these proinflammatory cytokines have been shown to induce Th17 cells and inhibit the re-differentiation of regulatory T cells, playing an important role in the development of many autoimmune diseases.…”

Perception of Quality of Life and Fatigue in Multiple Sclerosis Patients Treated with High-Dose Vitamin D

“…These mechanisms lead to a decline in the production of inflammatory cytokines, such as IL-12 and IL-17, and to an increase in anti-inflammatory cytokines, such as IL-10 [31]. VD also exerts its anti-inflammatory effects on monocytes, macrophages, and dendritic cells [32]. Due to these mechanisms, vitamin D deficiency has been associated not only with MS, but also with numerous other autoimmune, oncological, infectious, and cardiovascular diseases [33].…”