High-Dose Vitamin D Does Not Prevent Postoperative Recurrence of Crohn’s Disease
Monika Fischer, MD, reviewing de Bruyn JR, et al. Clin Gastroenterol Hepatol 2020 May 24.
The optimal vitamin D level for patients with IBD is highly debated. While a level >20 ng/L is sufficient for bone health even in high-risk individuals, experts recommend a level >30 ng/L for anti-inflammatory effects. Interventional trials with vitamin D, to date, have failed to provide conclusive evidence for this claim.
This multicenter, randomized, controlled trial from Belgium and the Netherlands investigated whether high-dose vitamin D can prevent postoperative recurrence of Crohn’s disease after ileocolonic resection. Patients were assigned to receive either weekly 25,000 IU oral vitamin D (n=72) or placebo (n=71) for 26 weeks. In the vitamin D group, serum levels of 25-hydroxy vitamin D doubled at week 26, increasing from a median of 42 nmol/L (16.8 ng/L) at baseline to 81 nmol/L (32.4 ng/L), but did not reduce endoscopic (modified Rutgeerts score ≥i2b) or clinical recurrence (Crohn’s disease activity index score ≥220) compared to placebo.
COMMENTVitamin D deficiency is common in patients with Crohn’s disease. Screening for and treatment of vitamin D deficiency is one of the quality measures of our daily clinical practice. However, it is not clear whether vitamin D deficiency is a cause for or a consequence of active disease. Preclinical data and trials without endoscopic endpoints suggested that higher levels of vitamin D were associated with lower rates of active disease and relapse. Using a more robust endpoint (centrally read, blinded endoscopic recurrence), this study found no protective effect of high-dose vitamin D and levels >30 ng/L in preventing Crohn’s disease recurrence after ileocolonic resection.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
de Bruyn JR, Bossuyt P, Ferrante M, et al.; on behalf of the Dutch-Belgian DETECT study group. High-dose vitamin D does not prevent postoperative recurrence of Crohn’s disease in a randomized placebo-controlled trial. Clin Gastroenterol Hepatol 2020 May 24. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.05.037)
