The effect of vitamin D on clinical outcomes in tuberculosis

Farazi, Aliasghar; Didgar, Farshideh; Sarafraz, Aghmorad

doi:10.1016/j.ejcdt.2017.01.004

Cited by 13 publications

(23 citation statements)

References 16 publications

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“…Notably, the serum levels of 25(OH)D did not increase in the intervention group after vitamin D supplementation , which together with the widely spaced dosing schedule may explain the lack of effect. A more recent study conducted in 60 TB patients in Iran who were given a single oral dose (11.25 mg) of adjunctive vitamin D reported a favourable effect on a similar TB score .…”

Section: Randomized Controlled Trials Investigating the Effects Of VImentioning

confidence: 90%

Vitamin D and tuberculosis: where next?

2018

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Tuberculosis (TB) has troubled mankind for millennia, but current treatment strategies are long and complicated and the disease remains a major global health problem. The risk of Mycobacterium tuberculosis (Mtb) infection or progression of active TB disease is elevated in individuals with vitamin D deficiency. High-dose vitamin D was used to treat TB in the preantibiotic era, and in vitro experimental data show that vitamin D supports innate immune responses that restrict growth of Mtb. Several randomized controlled trials have tested whether adjunctive vitamin D supplementation enhances the clinical and microbiological response to standard antimicrobial chemotherapy for pulmonary TB. The effects have been modest at best, and attention is turning to the question of whether vitamin D supplementation might have a role in preventing acquisition or reactivation of latent Mtb infection. In this article, we describe the effects of vitamin D on host immune responses to Mtb in vitro and in vivo and review the results of clinical trials in the field. We also reflect on the findings of clinical trials of vitamin D supplementation for the prevention of acute respiratory tract infections, and discuss how these findings might influence the design of future trials to evaluate the role of vitamin D in the prevention and treatment of TB.

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Section: Randomized Controlled Trials Investigating the Effects Of VImentioning

confidence: 90%

Vitamin D and tuberculosis: where next?

2018

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“…14 Farazi et al found an association between TB severity score with lower levels of serum calcidiol (p-value = 0.043) in Vitamin D (single dose of 450,000 IU) supplemented and placebo groups over 3 months. 19 Fisher's exact test [Chi-square (χ 2 )] analysis didn't demonstrate any significant difference in TB conversion between Group A and Group B at both day 30 (p-value 0.4238) and day 60 (p-value 0.0797). Thus, there is no sufficient evidence to say that vitamin D hastens the sputum conversion in smear positive PTB patients.…”

Section: Discussionmentioning

confidence: 97%

A study of vitamin D supplementation with directly observed treatment short course for Pulmonary Tuberculosis

Randhawa¹,

Jindal²,

Rai³

et al. 2017

Int J Basic Clin Pharmacol

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Background: Tuberculosis remains one of major global health problems due to growing resistance in TB bacilli against anti-tubercular treatment (ATT). Vitamin D3 has been reported to have immunostimulatory effect. Aim was to study effect of Vitamin D3 on efficacy and safety of ATT / Directly Observed Treatment, short course regimen.Methods: Prospective, randomized and interventional study of 90 days was carried out in 60 newly diagnosed sputum positive pulmonary tuberculosis patients on DOTS strategy. Study was conducted in Government Medical College, Amritsar, Punjab, India. 30 patients each were randomly divided into two groups, A and B, with group A - vitamin D3 and DOTS regimen and Group B - DOTS alone. Patients were evaluated on day 0, 30, 60 and 90 by TB score, sputum microscopy, laboratory investigations, and adverse drug events. At the end of 90 days, results were tabulated and data analyzed statistically applying relevant tests.Results: Statistically non-significant improvement in symptoms, sputum conversion and decrease in mean TB scores was seen in Group A vs B at 90 days. Significant increase in mean Vitamin D levels was seen in Group A at end of study. Insignificant difference in safety profile was observed in group A which showed additional adverse events suspected to be due to Vitamin D. Equivocal hepatoprotective effect of Vitamin D was observed.Conclusions: Vitamin D as adjuvant to ATT does not confer additional benefit to newly diagnosed pulmonary tuberculosis patients. Large multi-centric trials are required to find any benefit of Vitamin D supplementation with ATT.

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“…Eleven reported the time to sputum smear conversion [15,18,20,21,23,25,45,[47][48][49][50] and eight provided the time to sputum culture conversion [15,16,21,25,[46][47][48]50]. Six reported changes in BMI [14-16, 21, 23, 44], four presented changes in mean MUAC [14,15,23,45], ten provided the data on chest radiograph change [14,15,18,20,21,25,44,[46][47][48][49] and five presented results on TB clinical score changes [14,18,20,23,45]. Eleven presented the incidence of adverse events [15,16,18,20,21,25,[45][46][47]…”

Section: Description Of Outcomes Of Included Studiesmentioning

confidence: 99%

“…Six reported changes in BMI [14-16, 21, 23, 44], four presented changes in mean MUAC [14,15,23,45], ten provided the data on chest radiograph change [14,15,18,20,21,25,44,[46][47][48][49] and five presented results on TB clinical score changes [14,18,20,23,45]. Eleven presented the incidence of adverse events [15,16,18,20,21,25,[45][46][47][48]50], nine indicated the changes in weight gain [14,18,20,25,45,[47][48][49][50], eight provided the incidence of all-cause mortality [15,16,20,21,[45][46][47]50], four exhibited changes in CRP a...…”

Section: Description Of Outcomes Of Included Studiesmentioning

confidence: 99%

“…In addition to their anti-inflammatory functions, HDT may also provide other immune-modulating advantages. Vitamin D (cholecalciferol-D3) is a known immune modulator in TB, associated with cathelicidin-mediated killing of mycobacterium [22,23]. It has also been shown to suppress NF-κB signalling pathways, expression of matrix metalloproteinases (MMPs), and pro-inflammatory cytokines and chemokines, thus accelerating the resolution of inflammation [19].…”

Section: Introductionmentioning

confidence: 99%

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The effects of anti-inflammatory agents as host-directed adjunct treatment of tuberculosis in humans: a systematic review and meta-analysis

et al. 2020

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Background: The potential role of adjunctive anti-inflammatory therapy to enhance tuberculosis (TB) treatment has recently received increasing interest. There is, therefore, a need to broadly examine current host-directed therapies (HDTs) that could accelerate treatment response and improve TB outcomes. Methods: This systematic review and meta-analysis included randomised controlled trials of vitamin D and other HDT agents in patients receiving antibiotic treatment for pulmonary TB. Sputum smear conversion rate at 4-8 weeks was the primary outcome. Secondary outcomes included blood indices associated with infectivity and inflammation, chest radiology and incidence of adverse events. Results: Fifty-five studies were screened for eligibility after the initial search, which yielded more than 1000 records. Of the 2540 participants in the 15 trials included in the meta-analysis, 1898 (74.7%) were male, and the age at entry ranged from 18 to 70 years. There was a 38% significantly (RR 1.38, 95% CI = 1.03-1.84) increased sputum smear negativity in patients administered with vitamin D in addition to standard TB treatment than those receiving only the TB treatment. Patients treated with other HDT anti-inflammatory agents in addition to TB treatment also had a 29% significantly increased sputum smear conversion rate (RR 1.29, 95% CI = 1.09-1.563). Lymphocyte to monocyte ratio was significantly higher in the vitamin D treatment groups compared to the controls (3.52 vs 2.70, 95% CI for difference 0.16-1.11, p = 0.009) and (adjusted mean difference 0.4, 95% CI 0.2-0.6; p = 0.001); whilst tumour necrosis factor-alpha (TNF-α) showed a trend towards a reduction in prednisolone (p < 0.001) and pentoxifylline (p = 0.27) treatment groups. Vitamin D and N-acetylcysteine also accelerated radiographic resolution in treatment compared to placebo at 8 weeks. No differences were observed in the occurrence of adverse events among all HDT treatments.

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The effect of vitamin D on clinical outcomes in tuberculosis

Cited by 13 publications

References 16 publications

Vitamin D and tuberculosis: where next?

Vitamin D and tuberculosis: where next?

A study of vitamin D supplementation with directly observed treatment short course for Pulmonary Tuberculosis

The effects of anti-inflammatory agents as host-directed adjunct treatment of tuberculosis in humans: a systematic review and meta-analysis

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