Abstract: Vitamin D Deficiency As an Early Predictor of Long-Term Disease Activity in Patients Starting Interferon Beta-1b at Clinically Isolated Syndrome (2014 CMSC ACTRIMS Annual Meeting)

DX09
Vitamin D Deficiency As an Early Predictor of Long-Term Disease Activity in Patients Starting Interferon Beta-1b at Clinically Isolated Syndrome

Thursday, May 29, 2014

Trinity Exhibit Hall

Alberto Ascherio, MD , Harvard School of Public Health, Boston, MA

Kassandra Munger, ScD , Harvard School of Public Health, Boston, MA

Richard A White, MSc , University of British Columbia, Vancouver, BC, Canada

Karl Köchert, PhD , Bayer Pharma AG, Berlin, Germany

Kelly C Simon, ScD , Harvard School of Public Health, Boston, MA

Chris H Polman, MD , VU Medical Centre, Amsterdam, Netherlands

Mark S Freedman, MD , Ottawa Hospital Research Institute, Ottawa, ON, Canada

Hans-Peter Hartung, MD , Heinrich-Heine Universität, Dusseldorf, Germany

David H Miller, MD , National Hospital for Neurology and Neurosurgery, London, United Kingdom

Xavier Montalbán, MD , Hospital Universitari Vall d’Hebron, Barcelona, Spain

Gilles Edan, MD , CHU-Hôpital Pontchaillou, Rennes, France

Frederik Barkhof, MD, PhD , VU University Medical Center, Amsterdam, Netherlands

Dirk Pleimes, MD , Myelo Therapeutics GmbH, Berlin, Germany

Ernst W Radü, MD , University Hospital Basel, Basel, Switzerland

Rupert Sandbrink, MD , Bayer Pharma AG, Berlin, Germany

Ludwig Kappos, MD , University Hospital Basel, Basel, Switzerland

Christoph Pohl, MD , Department of Neurology, University Hospital of Bonn, Bonn, Germany

Background:

The BENEFIT study examined the effects of early vs delayed treatment with interferon beta-1b (IFNB-1b) for patients with clinically isolated syndrome (CIS). In prior analyses, dichotomized 25-hydroxyvitamin D (25[OH]D) classes contributed to the prediction of rate of conversion to clinically definite multiple sclerosis (CDMS), MS activity, and rate of progression up to 5 years after CIS in patients starting IFNB-1b treatment at the CIS or after conversion to CDMS.

Objectives:

To examine the predictive effects of continuous 25(OH)D on disease activity and prognosis in patients starting IFNB-1b at the CIS.

Methods:

Only patients who were randomized to early IFNB-1b treatment in BENEFIT with serum 25(OH)D concentrations assessed at baseline, 6, 12, and 24 months were included in this analysis. Clinical and MRI follow-up lasted for 5 years. Cox proportional hazard models or generalized mixed effects models related seasonally-adjusted serum 25(OH)D concentrations to conversion to CDMS, conversion to McDonald MS (MDMS), rate of newly active lesions, relapse rate, T2 volume, and brain volume by assessing changes in these variables from Year 1 to Year 5.

Results:

216 patients had 25(OH)D measurements at both 6 and 12 months. Each 50 nmol/L (20 ng/mL) increase in 25(OH)D led to a lower probability of conversion to MDMS (hazard ratio [HR] [95% CI] 0.43 [0.22 to 0.84], p=0.01], with a trend toward lower probability of conversion to CDMS (HR 0.48 [0.22 to 1.04], p=0.06). Rates of newly active lesions (rate ratio [RR] .31 [.15 to .61], p=0.0008) and relapses (RR .38 [.14 to .99], p=0.048] also decreased with increasing 25(OH)D levels. Annual percent change in T2 volume (-26% [-39% to -12%], p=0.0007) and brain volume (.64% [.08% to 1.2%], p=0.02) were lower with each incremental increase in 25(OH)D.

Conclusions:

Among patients who started IFNB-1b treatment right after CIS, incremental increases in 25(OH)D levels were associated with reduction of long-term MS activity and severity. These findings suggest a potential benefit of monitoring and managing vitamin D levels (eg, through supplementation) in early MS patients treated with IFNB-1b.

DX09 Vitamin D Deficiency As an Early Predictor of Long-Term Disease Activity in Patients Starting Interferon Beta-1b at Clinically Isolated Syndrome

DX09
Vitamin D Deficiency As an Early Predictor of Long-Term Disease Activity in Patients Starting Interferon Beta-1b at Clinically Isolated Syndrome