Implementation of high-dose oral vitamin D therapy in pediatric patients with inflammatory bowel disease receiving infliximab or vedolizumab infusions
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Abstract
BACKGROUND: Vitamin D is pivotal in maintaining intestinal immunity, epithelial function, and the gut microbiome. Vitamin D insufficiency is becoming increasingly prevalent in the general population due to several factors, including geography, diet, and non-adherence to long-term supplementation. There is an even greater prevalence of vitamin D deficiency in patients with inflammatory bowel disease (IBD), likely resulting from insufficient intake and malabsorption induced by intestinal inflammation. This study aims to investigate the safety and efficacy of high-dose vitamin D therapy for use in children and adolescents with IBD. OBJECTIVES: The primary aim was to evaluate the safety and efficacy of interval high-dose vitamin D therapy. The secondary aim was to assess the impact of such intervention on quality of life and immunologic markers of IBD-related inflammation. METHODS: Patients aged 5-25 years with an established diagnosis of IBD and a baseline vitamin D level below 40 were eligible for participation in this study. Eligibility was further limited to patients being treated with infliximab or vedolizumab. Patients received eight or nine doses of vitamin D during the study. Data was collected at various points, including survey responses, serum 25-OHD levels, and safety labs.
RESULTS: Serum 25-OHD levels increased significantly throughout the study, with the average value at baseline being 24.8 ± 5.1 ng/mL and the average at the study's conclusion being 43.0 ± 10.2 ng/mL. Urine calcium/creatinine ratios did not change in response to high-dose vitamin D treatment. Similarly, patient quality of life scores (assessed as IMPACT-III) did not change significantly from baseline to the final study visit. CONCLUSION: The use of interval high-dose therapy was safe and effective in increasing vitamin D levels in children and adolescents with IBD and did not negatively impact patient quality of life. Further research is warranted to assess the impact of higher ambient vitamin D levels on epithelial and lymphocyte function in patients with IBD and other chronic immune-mediated diseases.
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2024