Vitamin D and Multiple Sclerosis
Supplementation and therapeutic use of vitamin D in patients with multiple sclerosis: Consensus of the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology

Doralina Guimarães Brum (1), Elizabeth Regina Comini-Frota (2), Claúdia Cristina F. Vasconcelos (3), Elza Dias-Tosta (4)

1) Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu SP, Brazil;
2) Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil;
3) Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil;
4) Hospital de Base do Distrito Federal, Brasília DF, Brazil.

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Considering the body of information presented here, the DCNI/ABN defines the consensus that:
February 2014

1. It is recommended to dose vitamin D in patients with clinically isolated syndrome and MS, regardless of the stage of disease, particularly those making frequent use of corticosteroids or anticonvulsivants.

2. Peripheral blood levels of vitamin D lower than 30ng/ml [75 nmol/L] should be corrected in patients with MS, at any stage, or in patients with demyelinating isolated syndrome (grade D recommendation).

3. Peripheral blood levels of vitamin D higher than 100 ng/ml [250 nmol/L] should be avoided until new guidelines are established (grade D recommendation).

4. There is no scientific evidence up to the production of this consensus for the use of vitamin D as monotherapy for MS in clinical practice. Therefore, currently, vitamin D monotherapy for MS is considered
experimental. For its use in clinical trials, these must be approved by the Human Research Ethics Committee, regulated by the National Commission for Ethics in Research (CONEP), approved by the Regional Medical Board, and informed consent should be provided by patients.

5. According to data from in vitro studies with peripheral blood cells of patients using vitamin D, serum levels above 40 ng/ml [100 nmol/L] are likely to cause modulating action on immune cells(17). Based on that evidence, vitamin D supplementation at doses that maintain serum levels of patients between 40 ng/ml [100 nmol/L] and 100 ng/ml [250 nmol/L] may be recommended, as these are safe levels (grade D recommendation).

6. Considering the individual differences in replacement needs and serum levels of vitamin D, that a study in healthy subjects showed that 5,000 IU/day of vitamin D3 (cholecalciferol) for 15 weeks increased serum levels up to 60 ng/ml [150 nmol/L] , and that doses up to 10,000 IU/day were considered safe, we recommend individualized doses until reaching serum levels between 40 ng/ml [100 nmol/L] and 100 ng/ml [250 nmol/L] (grade D recommendation).

7. Considering that low vitamin D serum levels in patients with isolated demyelinating syndrome could affect the relative risk of conversion to MS(16), we recommend the analysis of serum vitamin D levels in those patients and that a correction is made whenever necessary (grade D recommendation).

8. Because vitamin D3 is a secosteroid hormone, its use should be escalated. Moreover, monitoring serum 25-hydroxivitamin D would be extremely important before increasing dosage to determine whether supplementation is actually effective (grade D recommendation).

List of contributors: Amilton Antunes Barreira, Antônio Pereira Gomes Neto, Cláudio Roberto Carneiro, Carlos Augusto de Albuquerque Damasceno, Daniel Lima Varela, Damácio Rámon Kaimen-Maciel, Denis Bernardi Bichuetti, Denise Sisterolli Diniz, Eber Castro Correa, Elizabeth Batista da Silva, Fabio Siquineli, Fernando Coronetti Gomes da Rocha, Felipe von Glehn Silva, Fernando Faria Andrade Figueira, Gutemberg Augusto Cruz dos Santos, Heloise Helena de Figueiredo Siqueira, Jefferson Becker, Leandro Cortoni Calia, José Mauricio Godoy Barreiros, Luiz Domingos Mendes Melges, Marcos Aurélio Moreira, Marcos Papais-Alvarenga, Maria Cecília Aragon de Vecino, Maria Cristina Brandão de Giacomo, Maria Fernanda Mendes, Maria Lúcia Brito Ferreira, Maria Lúcia Vellutini Pimentel, Monica Koncke Fiuza Parolin, Nívea de Macedo Oliveira Morales, Osvaldo J.M. do Nascimento, Paulo Pereira Christo, Regina Maria Papais Alvarenga, Renata Brandt de Souza, Renato Puppi Munhoz, Rogério de Rizo Morales, Sidney Gomes, Solange Maria das G. G. Camargo, Soniza Vieira Alvez-Leon, Suzana Costa Nunes Machado, Tarso Adoni, Thereza Cristina D`Avila Winckler, Thiago de Faria Junqueira, Yara Dadalti Fragoso, and Yuna de Ribeiro Araújo. External collaborators: Alessandro Farias (researcher), Eduardo Antônio Donadi (immunologist), and Marcelo de Paula Corrêa (meteorologist).

Grade Definitions
Strength of Recommendations

The U.S. Preventive Services Task Force (USPSTF) grades its recommendations according to one of five classifications (A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms).

D - The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.

November 10, 2009
Vitamin D and MS: Implications for Clinical Practice (pdf, 188 KB)
Allen C. Bowling, MD, PhD
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Page last edited: October 10, 2015
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