Oral Calcidiol Is More Effective Than Cholecalciferol Supplementation to Reach Adequate 25(OH)D Levels in Patients with Autoimmune Diseases Chronically Treated with Low Doses of Glucocorticoids: A “Real-Life” Study

Abstract

Glucocorticoids (GCs) are the cornerstone of the therapy in many autoimmune and inflammatory diseases. However, it is well known that their use is a double edged sword, as their beneficial effects are associated almost universally with unwanted effects, as, for example glucocorticoid-induced osteoporosis (GIO). Over the last years, several clinical practice guidelines emphasize the need of preventing bone mass loss and reduce the incidence of fractures associated with GC use. Calcium and vitamin D supplementation, as adjunctive therapy, are included in all the practice guidelines. However, no standard vitamin D dose has been established. Several studies with postmenopausal women show that maintaining the levels above 30–33 ng/mL help improve the response to bisphosphonates. It is unknown if the response is the same in GIO, but in the clinical practice the levels are maintained at around the same values. In this study we demonstrate that patients with autoimmune diseases, undergoing glucocorticoid therapy, often present suboptimal 25(OH)D levels. Patients with higher body mass index and those receiving higher doses of glucocorticoids are at increased risk of having lower levels of 25(OH)D. In these patients, calcidiol supplementations are more effective than cholecalciferol to reach adequate 25(OH)D levels.

A 25-Hydroxycholecalciferol–Fortified Dairy Drink Is More Effective at Raising a Marker of Postprandial Vitamin D Status than Cholecalciferol in Men with Suboptimal Vitamin D Status

“…The relative efficacy of 25-hydroxycholecalciferol [25(OH)D 3 ] and cholecalciferol (vitamin D 3 ) for improving vitamin D status is inconsistent between studies (9-15), yet it has generally been found that 25(OH)D 3 supplementation can increase vitamin D status more efficiently than vitamin D 3 after a single dose (15) or after longer-term supplementation from 1 mo to 1 y (9)(10)(11)(12)(13)(14). In addition, Jetter et al (15) have studied both the pharmacokinetics of a single dose and chronic supplementation for 15 wk with vitamin D 3 and 25(OH)D 3 .…”

MANAGEMENT OF ENDOCRINE DISEASE: Therapeutics of vitamin D

“…It is also a logical form of vitamin D to use in the setting of glucocorticoidinduced inhibition of hepatic 25-hydroxylase. (15). Since glucocorticoids may inhibit not only the hepatic 25-hydroxylation of vitamin D, but also the subsequent 1-hydroxylation step in the kidney, to form active calcitriol, the use of calcitriol has been proposed as a way of bypassing both hydroxylation steps for the treatment of glucocorticoid-induced osteoporosis (GIOP).…”

25(OH)D3-enriched or fortified foods are more efficient at tackling inadequate vitamin D status than vitamin D3

“…Five of the eleven studies ( 47 , 49 – 52 ) supplemented 25(OH)D 3 to generally healthy subjects, whereas the other six studies ( 46 , 48 , 53 – 56 ) supplemented 25(OH)D 3 to clinical patients. Most studies reported the serum or plasma 25(OH)D concentration at both the beginning and end of the treatment, except one study ( 55 ) , which only reported the 25(OH)D concentration at the end of the treatment. In terms of the vitamin D status measurement, most studies measured total 25(OH)D concentration, except two studies ( 49 , 52 ) , which measured 25(OH)D 3 .…”

“…In terms of the vitamin D status measurement, most studies measured total 25(OH)D concentration, except two studies ( 49 , 52 ) , which measured 25(OH)D 3 . For the characteristics of the investigated subjects, five studies included both men and women ( 46 , 48 , 51 , 53 , 55 ) , while the other studies only included men or women. In addition, most studies reported the age and BMI of the subjects, except two studies ( 46 , 48 ) that did not report the BMI range.…”

“…Therefore, the studies using 25(OH)D 3 treatments in patients were also summarised in Table 4 ( 46 , 48 , 53 – 56 ) , and those studies consistently reported that chronic 25(OH)D 3 supplementation effectively increased serum 25(OH)D concentrations. For example, Ortego-Jurado et al showed a lower daily dose of 8·85 µg 25(OH)D 3 to be more effective than a 20 µg dose of vitamin D 3 for increasing vitamin D status in patients with autoimmune disease who were treated with a low dose of glucocorticoids throughout the year ( 55 ) . Similarly, the study of Banon et al showed that a monthly dose of 400 µg 25(OH)D 3 was safe and effective at improving vitamin D status of HIV-infected patients throughout the year ( 53 ) .…”