Interferon B e vitamina d

Revista: Neurology

Interferon-β and serum 25-hydroxyvitamin D interact to modulate relapse risk in MS

1. Niall Stewart, PhD*,
2. Steve Simpson Jr, MPH*,
3. Ingrid van der Mei, PhD,
4. Anne-Louise Ponsonby, PhD,
5. Leigh Blizzard, PhD,
6. Terrence Dwyer, MD,
7. Fotini Pittas, PhD,
8. Darryl Eyles, PhD,
9. Pauline Ko, BHons and
10. Bruce V. Taylor, MD

+ Author Affiliations

1. From the Menzies Research Institute Tasmania (N.S., S.S., I.v.d.M., L.B., B.V.T.) and School of Medicine (F.P.), University of Tasmania, Hobart; Murdoch Children's Research Institute (A.-L.P., T.D.), Royal Children's Hospital, Melbourne; and Queensland Brain Institute (D.E., P.K.), University of Queensland, St Lucia, Australia.

1. Correspondence & reprint requests to Dr. Taylor: bruce.taylor@utas.edu.au

+ Author Disclosures: Niall Stewart

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+ Author Disclosures: Steve Simpson Jr

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+ Author Disclosures: Ingrid van der Mei

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1. National Health and Medical Research Council of Australia; Multiple Sclerosis Research Australia

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+ Author Disclosures: Anne-Louise Ponsonby

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1. non-profit entity, National MS SOCIETY, USA, reimbursement of travel costs non-profit entity, Keystone Symposia, USA, reimbursement of travel costs non-profit entity, MS Canada, reimbursement of travel costs

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1. National Health and Medical Research Council of Australia

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+ Author Disclosures: Leigh Blizzard

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+ Author Disclosures: Terrence Dwyer

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1. National Health and Medical Research Council of Australia

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+ Author Disclosures: Fotini Pittas

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+ Author Disclosures: Darryl Eyles

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1. Project Grants 511066 (2008-2010), 569528 (2009-2011), and 623208

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+ Author Disclosures: Pauline Ko

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1. NONE

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+ Author Disclosures: Bruce V. Taylor

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Funding for Travel or Speaker Honoraria:

1. Funding to travel to World Congress of MS Montreal September 2008 from Schering Bayer Schering Pharma Pty Ltd Funding for travel and accommodation from MS Society of Western Australia to speak at their 2008 scientific. meeting. Funding from Bayer Schering Pharma to present a series of lectures in South East Asia March 2008 Invited Guest speaker at Asia pacific MS forum funded by Bayer Schering Pharma Pty Ltd Invited guest speaker INDAPS meeting Melbourne Nov 2008 funded by CSL Pty Ltd Austrlaia. Funding to travel to AAN meeting Seattle 2009 from Bayer Schering Pharma. Funding to travel to ECTRIMS Gothenberg 2010 from Bayer Schering Pharma.

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1. International MS Journal Editorial Advisary Board 2009 - 2011

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1. Honoraria received from MS society of Western Australia for speaking at the 2008 Scientific meeting

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Research Support, Government Entities:

1. NHMRC australia project grant support.2008-9.490020, 2009 544922 2010 HRC New Zealand project grant support.2007-8 05/524 National MS Society of USA project grant support Australian research Council and MS Research Australia 2007-9 LP0776744 National MS society of US project grant funding

Research Support, Academic Entities:

1. NONE

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1. Ms society of Tasmania research fellowship support 2007 - 2009

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View Complete Disclosures

Abstract

Objective: To determine whether interferon-β (IFN-β) medication use is associated with vitamin D levels and whether the two interact in exerting effects on relapse risk.

Methods: In a prospective cohort of 178 persons with clinically definite multiple sclerosis (MS) living in southern Tasmania in 2002–2005, serum 25-hydroxyvitamin D [25(OH)D] was measured biannually, with assessment by questionnaire for relevant factors, including IFN-β treatment.

Results: Subjects reporting IFN-β use had significantly higher mean 25(OH)D than persons who did not (p < 0.001). This was mediated by an interaction between personal sun exposure and IFN-β, with treated persons realizing nearly three times 25(OH)D per hour of sun exposure of persons not on therapy. The association between 25(OH)D and 1,25-dihydroxyvitamin D did not differ by IFN-β therapy (p = 0.82). 25(OH)D was associated with a reduced relapse risk only among persons on IFN-β (p < 0.001). Importantly, IFN-β was only protective against relapse among persons with higher 25(OH)D (hazard ratio [HR] 0.58 [95% confidence interval (CI) 0.35–0.98]), while among 25(OH)D-insufficient persons, IFN-β increased relapse risk (HR 2.01 [95% CI 1.22–3.32]).

Conclusion: In this study, we found that IFN-β therapy is associated with greater production of vitamin D from sun exposure, suggesting part of the therapeutic effects of IFN-β on relapse in MS may be through modulation of vitamin D metabolism. These findings suggest persons being treated with IFN-β should have vitamin D status monitored and maintained in the sufficiency range.

Classification of evidence: This study provided Class III evidence that IFN-β is associated with reduced risk of relapse, and this effect may be modified by a positive effect of IFN-β on serum 25(OH)D levels.