Efecto del tratamiento con vitamina D sobre los niveles séricos de 25 hidroxivitamina D en pacientes con enfermedad inflamatoria intestinal y su influencia sobre la actividad de la enfermedad y la calidad de vida

Resumen

INTRODUCTION Hypovitaminosis D is very common among patients with inflammatory bowel disease (IBD). More and more actions of vitamin D not related to calcium homeostasis are known. Vitamin D deficiency has been implicated in several pathologies, such as IBD and different studies associate it with a worse evolution of the disease. Vitamin D supplements have been postulated as a hopeful treatment, however, the evidence is scarce and the optimal dose is unknown. METHOD A cross-sectional study was conducted with IBD outpatients from two hospitals in Murcia to analyze the prevalence of deficiency (<20 ng/ml) and suboptimal levels of 25(OH)D (<30 ng/ml), as well as the factors associated. Subsequently, an ambispective follow-up study was conducted for 6 months in those patients with 25(OH)D <30 ng/ml who started treatment with vitamin D. The main objective was to evaluate changes in the concentration of 25(OH)D at 3 and 6 months according to the treatment regimen used: continuous vs. pulse-shaped. A Mixed ANOVA was used. We studied whether the increase in levels of 25(OH)D >30 ng/ml was associated with an improvement in clinical activity index, in analytical activity parameters (CRP and FCP) and in quality of life questionnaires (IBDQ-9), fatigue severity (FSS) and psychological distress (GHQ-12). RESULTS Ninety-four patients participated in the cross-sectional study. The prevalence of suboptimal levels of 25(OH)D was 70.2%. FCP levels > 250 mcg/g were associated with suboptimal vitamin D levels (OR 4,04 (CI95%1,06-15,31); p=0,04) while fewer hours of sun exposure were associated with vitamin D deficiency (OR 0,922 (CI95% 0,85-0,99); p=0,047). The ambispective study involved 89 patients who received 4 different regimens of calcifediol: 1 and 3 where the entire dose was administered in the first three months; 2 and 4, spread over 6 months. Regimen 1 (Ampoule of calcifediol 3 mg, 0-2 months, n=20) was compared with regimen 3 (2 capsules of calcifediol 0.266 mg weekly for 3 months, n=16). Although similar changes in 25(OH)D concentrations occurred, the proportion of patients with optimal 25(OH)D levels at 6 months was higher with regimen 3 (30% vs.62,5%, p=0,016). Regimen 2 (Ampoule of calcifediol 3 mg, 0-3 months, n=24) was compared with regimen 4 (1 capsule of calcifediol 0.266 mg weekly for 3 months and then 1 capsule every 15 days, n=28). The latter achieved at 3 months a higher proportion of patients with optimal concentrations (96% vs. 53%) and a higher mean at 25(OH)D levels (63,91 vs. 31,45 ng/ml) (p<0,001). There was no difference at 6 months. The variables that were associated with suboptimal levels of vitamin D at 3 months were: elevated BMI (OR 1,3 (CI95% 1,03-1,63); p=0,023), the low score on the IBDQ-9 scale (OR 0,73 (CI95% 0,57-0,93); p=0,01) and treatment regimen 2 (OR 66,9 (CI95% 2,17-2062); p=0,016). At 6 months it was the FCP > 250 mcg/g (OR 4,01 (CI95% 1,19-13,54); p = 0,025) and treatment regimen 1 (OR 12,03 (CI95% 2,39- 60,57); p=0,003). CONCLUSIONS The prevalence of suboptimal levels of 25(OH)D among IBD patients was elevated and associated with increased disease activity (FCP). Treatment with calcifediol was safe. The regimens used achieved adequate increases in the concentration of 25(OH)D. The continued regimen of 1 capsule calcifediol 0.266 mg weekly for 3 months and then 1 every 15 days achieved the best profile of effectiveness and safety.