Very high-dose ergocalciferol is effective for correcting vitamin D deficiency in children and young adults with cystic fibrosis

Abstract

Approximately 10-80% of patients with Cystic Fibrosis (CF) have vitamin D deficiency. Obtaining therapeutic vitamin D levels has been a challenge for CF care providers using current recommended high-dose oral ergocalciferol (400,000 IU over 2 months). The objective of this study was to evaluate the safety and efficacy of a 2-week, very high dose ergocalciferol (700,000 IU over 14 days) repletion strategy in children and young adults with CF. As part of a quality improvement initiative, a prospective cohort study was performed from January through May 2007. Phase I included identifying individuals with CF who were subtherapeutic in 25-OH D. In phase II, 50,000 IU of ergocalciferol was prescribed for a 14 day term and administered daily. During phase III, a post treatment 25-OH D level was obtained to determine improvement. Baseline demographics and clinical characteristics were obtained at study entry. Stratification of the post 25-OHD levels was defined. Eighteen individuals with CF participated in the study. The mean age was 17+/-5 years (range 6-25 years). One hundred percent were pancreatic insufficient and required pancreatic enzyme replacement. All 18 had 25-OHD levels less than 30 ng/mL pre-treatment. Seventeen of the 18 (94%) participants became therapeutic in the 2-week interval. No patients had values considered high abnormal (100-150 ng/mL) or toxic (>150 ng/mL). Mean change was noted at an increase of 37.3+/-22 ng/mL in the 2-week period (p<0.001). Pre and peripubertal individuals had a significantly greater increase in 25-OH D levels. The results of this study demonstrate that very high dosing of vitamin D using oral ergocalciferol over a 14 day period is an effective strategy in achieving therapeutic levels of 25-OH vitamin D in children and young adults with CF. We believe this regimen deserves further study.

Pilot study of vitamin D supplementation in adults with cystic fibrosis pulmonary exacerbation

“…We found a striking improvement in vitamin D status at 1 week with a trend for improved status over 12 weeks. As has been observed in other studies of high dose vitamin D, we found no adverse effects relating to hypervitaminosis D or hypercalcemia in the vitamin D group 2 , 17 , 18 …”

Transient effectiveness of vitamin D2 therapy in pediatric cystic fibrosis patients

“…Since multiple studies have demonstrated a high prevalence of vitamin D insufficiency, various repletion strategies are being studied in an attempt to find the appropriate repletion and maintenance strategy for vitamin D deficiency in CF patients [22][23][24][25]. One option which is gaining support is to use vitamin D 3 (cholecalciferol) instead of vitamin D 2 (ergocalciferol) in repletion regimens since vitamin D 3 may be more effective [26,27].…”

Influence of Season, Ethnicity, and Chronicity on Vitamin D Deficiency in Traumatic Spinal Cord Injury

“…Because the range between the perceived normal vitamin D25(OH) starting point of 20 ng/mL and the higher level of 32 ng/mL remains an issue of debate, some have termed all serum vitamin D25(OH) values ,32 ng/mL as subtherapeutic (13). For this study, we considered serum vitamin D25(OH) values ,32 ng/mL to be subtherapeutic, levels specifically ,20 ng/mL insufficient, and those ,12 ng/mL deficient.…”