Activated Vitamin D trial

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The effect of 1-hydroxy-vitamin D treatment in hospitalized patients with COVID-19: A retrospective study

Vitamin D deficiency is associated with elevated risk, severity, and mortality

Asthma, tuberculosis, chronic pulmonary obstructive disease (COPD), and viral respiratory infections

Consistent paper 1.

Vitamin D and its therapeutic relevance in pulmonary diseases

Vitamin D essential for several cellular processes, wound healing, immunity inflammation

Studies have displayed strong inter-relations with vit D deficiency and progression of lung disorders

Its ease of supplementation and development of personalized medicine,

could lead us to an effective adjunct and cost-effective method of therapeutic modality for highly fatal pulmonary diseases.

Consistent paper 2.

Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths

To reduce the risk of infection,

it is recommended that people at risk of influenza and/or COVID-19,

consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25(OH)D concentrations,

followed by 5000 IU/d.

The goal should be to raise 25(OH)D concentrations above 40–60 ng/mL (100–150 nmol/L).

For treatment of people who become infected with COVID-19, higher vitamin D3 doses might be useful.

Vitamin D deficiency is relatively common

Especially among the elderly, the obese, and patients with comorbidities including hypertension, diabetes, COPD, and CKD

Vitamin D induces

Production of antiviral peptides (defensins),

especially in the respiratory epithelium

Vitamin D upregulates anti-inflammatory cytokines such as interleukin-10 (IL-10),

and downregulates pro-inflammatory cytokines including IL-1, IL-6, and tumor necrosis factor alfa

Vitamin D effects angiotensin-converting enzyme axis,

which has a protective effect against ARDS

Efficacy of activated vitamin D supplementation in coronavirus disease 2019 (COVID-19)

1-hydroxy-vitamin D was prescribed on day 1 or 2 (median duration 8 days)

To evaluate the effect of 1-hydroxy-vitamin D,

on the prevention of severe disease and mortality,

in patients hospitalized for COVID-19.

Retrospective study, April 2021 and October 2021

Primarily Delta variant

Hospitalised 312 patients with COVID-19

Between July 2022 and September 2022

Primarily Omicron variant

Serum 25-hydroxyvitamin D (25(OH)D) levels measured at admission

1-hydroxy-vitamin D was prescribed

Primary composite endpoints

Need for additional respiratory support

Need for high-flow oxygen therapy or invasive mechanical ventilation

In-hospital mortality rate.

Experimental group

(n = 122)

Given 1-hydroxy-vitamin D

Median age, 66

Baseline vitamin D deficient, 77%

Control group ( n = 190)

Median age, 58

Age difference (p = 0.06)

Baseline vitamin D deficient, 65%

Baseline D deficiency

(p = 0.07)

(defined as serum 25(OH)D level less than 20 ng/mL)

Proportion of those requiring more respiratory support and in-hospital mortality

Vit D group, 6%

Control group,14%

(p = 0.01)

After propensity score matching

(to reduce bias caused by confounding variables)

(P = 0.03 log-rank test)

Proportion of patients who received high flow oxygen

Vit D group 4%

Control group, 11% (P = 0.04)

In-hospital mortality

Vit D group, 3%

Control group, 5% (P = 0.3).

Need for additional respiratory support

Vit D group, 6%

Control group, 14% (P = 0.01)

Conclusions

1-hydroxy-vitamin treatment may improve outcomes in hospitalized patients with COVID- 19,

reducing composite outcomes including the need for additional respiratory support and in-hospital mortality.