Vitamin D is a fat-soluble vitamin that functions as a pro-hormone. Vitamin D’s effects on immune function have been the topic of much recent research in COVID. “It has been proposed that the activation of the Vitamin D receptor (VDR) signaling pathway may generate beneficial effects in Acute Respiratory Distress Syndrome (ARDS) by decreasing the cytokine/chemokine storm, regulating the renin-angiotensin system, modulating neutrophil activity and by maintaining the integrity of the pulmonary epithelial barrier, stimulating epithelial repair and tapering down the increased coagulability.” A recent pilot study published August 29, 2020 highlighted below is a randomized, double-masked clinical trial of 76 patients hospitalized for COVID with 50 patients in the VItamin D supplementation group and 26 patients in the control group. The study showed that administration of high doses of calcifediol (which rapidly raises serum D levels) or 25-hydroxyvitamin D to hospitalized COVID-19 patients significantly reduced their need for ICU admission.
“Effect of Calcifediol Treatment and best Available Therapy versus best Available Therapy on Intensive Care Unit Admission and Mortality Among Patients Hospitalized for COVID-19: A Pilot Randomized Clinical study”
The vitamin D endocrine system may have a variety of actions on cells and tissues involved in COVID-19 progression especially by decreasing the Acute Respiratory Distress Syndrome. Calcifediol can rapidly increase serum 25OHD concentration. We therefore evaluated the effect of calcifediol treatment, on Intensive Care Unit Admission and Mortality rate among Spanish patients hospitalized for COVID-19.
parallel pilot randomized open label, double-masked clinical trial.
university hospital setting (Reina Sofia University Hospital, Córdoba Spain.)
76 consecutive patients hospitalized with COVID-19 infection, clinical picture of acute respiratory infection, confirmed by a radiographic pattern of viral pneumonia and by a positive SARS-CoV-2 PCR with CURB65 severity scale (recommending hospital admission in case of total score > 1).
All hospitalized patients received as best available therapy the same standard care, (per hospital protocol), of a combination of hydroxychloroquine (400 mg every 12 hours on the first day, and 200 mg every 12 hours for the following 5 days), azithromycin (500 mg orally for 5 days. Eligible patients were allocated at a 2 calcifediol:1 no calcifediol ratio through electronic randomization on the day of admission to take oral calcifediol (0.532 mg), or not. Patients in the calcifediol treatment group continued with oral calcifediol (0.266 mg) on day 3 and 7, and then weekly until discharge or ICU admission. Outcomes of effectiveness included rate of ICU admission and deaths.
Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%) p value X2 Fischer test p < 0.001. Univariate Risk Estimate Odds Ratio for ICU in patients with Calcifediol treatment versus without Calcifediol treatment: 0.02 (95%CI 0.002-0.17). Multivariate Risk Estimate Odds Ratio for ICU in patients with Calcifediol treatment vs Without Calcifediol treatment ICU (adjusting by Hypertension and T2DM): 0.03 (95%CI: 0.003-0.25). Of the patients treated with calcifediol, none died, and all were discharged, without complications. The 13 patients not treated with calcifediol, who were not admitted to the ICU, were discharged. Of the 13 patients admitted to the ICU, two died and the remaining 11 were discharged.
Our pilot study demonstrated that administration of a high dose of Calcifediol or 25-hydroxyvitamin D, a main metabolite of vitamin D endocrine system, significantly reduced the need for ICU treatment of patients requiring hospitalization due to proven COVID-19. Calcifediol seems to be able to reduce severity of the disease, but larger trials with groups properly matched will be required to show a definitive answer.
Keep an eye out for the results of the larger follow-up being conducted at 15 hospitals in Spain titled “Prevention and Treatment with Calcifediol of Coronavirus-induced Acute Respiratory Syndrome (SARS) COVD-19” (NCT04366908).
Thank you to those who attended our recent CE webinar where our very own Dr. Paul Chous spoke on “What’s New and Still True in the Prevention of Diabetic Retinopathy”. Please stay tuned for an invitation to our next live CE event on September 29 by our very own Dr. Pinakin Davey who will discuss carotenoid science as it pertains to ocular and systemic health. We at OWNS wish each of you, your families, and patients a very happy and safe Labor Day Weekend. Be sure to get your Vitamin D.