Pretreatment 25-hydroxyvitamin D levels and durability of anti-tumor necrosis factor-α therapy in inflammatory bowel diseases.

Abstract

INTRODUCTION:

Emerging evidence supports an immunologic role for 25-hydroxyvitamin D (25(OH)D) in inflammatory bowel disease (IBD). Here we examined if pretreatment vitamin D status influences durability of anti-tumor necrosis factor (TNF)-α therapy in patients with Crohn's disease (CD) or ulcerative colitis (UC).

METHODS:

All IBD patients who had plasma 25(OH)D level checked <3 months prior to initiating anti-TNF-α therapy were included in this retrospective single-center cohort study. Our main predictor variable was insufficient plasma 25(OH)D (<30 ng/mL). Cox proportional hazards model adjusting for potential confounders was used to identify the independent effect of pretreatment vitamin D on biologic treatment cessation.

RESULTS:

Our study included 101 IBD patients (74 CD; median disease duration 9 years). The median index 25(OH)D level was 27 ng/mL (interquartile range, 20-33 ng/mL). One-third of the patients had prior exposure to anti-TNF-α therapy. On multivariate analysis, patients with insufficient vitamin D demonstrated earlier cessation of anti-TNF-α therapy (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.03-4.39; P = .04). This effect was significant in patients who stopped treatment for loss of response (HR, 3.49; 95% CI, 1.34-9.09) and stronger for CD (HR, 2.38; 95% CI, 0.95-5.99) than UC (P = NS).

CONCLUSIONS:

Our findings suggest that vitamin D levels may influence durability of anti-TNF-α induction and maintenance therapy. Larger cohort studies and clinical trials of supplemental vitamin D use with disease activity as an end point may be warranted.

• Authors: Zachary A Zator, Stephanie M Cantu, Gauree Gupta Konijeti, Deanna D Nguyen, Jenny Sauk, Vijay Yajnik, Ashwin N Ananthakrishnan
• Journal: JPEN. Journal of parenteral and enteral nutrition (JPEN J Parenter Enteral Nutr) 2014 Mar-Apr Vol. 38 Issue 3 Pg. 385-91 ISSN: 1941-2444 [Electronic] United States
• PMID: 24088707 (Publication Type: Journal Article)

Chemical References

• Tumor Necrosis Factor-alpha
• Vitamin D
• 25-hydroxyvitamin D

Topics

• Adolescent
• Adult
• Dietary Supplements
• Female
• Follow-Up Studies
• Humans
• Inflammatory Bowel Diseases (blood, complications, drug therapy)
• Male
• Proportional Hazards Models
• Retrospective Studies
• Sensitivity and Specificity
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Vitamin D (analogs & derivatives, blood)
• Vitamin D Deficiency (blood, complications)
• Young Adult