SHORT REPORT

A pilot study of oral calcitriol (1,25-dihydroxyvitamin D₃) for relapsing–remitting multiple sclerosis

D M Wingerchuk¹, J Lesaux², G P A Rice², M Kremenchutzky², G C Ebers³

¹ Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
² Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada
³ Department of Clinical Neurology, University of Oxford, Oxford, UK

Correspondence to:
Correspondence to:
Dr Dean M Wingerchuk
Mayo Clinic, Scottsdale, Arizona, USA; wingerchuk.dean{at}mayo.edu

Background: Epidemiological and ecological studies suggest links between vitamin D deficiency and increased multiple sclerosis (MS) prevalence.

Objective: To evaluate the safety and tolerability of oral calcitriol therapy in an open label pilot study.

Methods: 15 ambulatory patients with relapsing–remitting MS and at least one clinical relapse within the previous 12 months received oral calcitriol (target dose: 2.5 µg/d) for 48 weeks. Dietary calcium was restricted to 800 mg/d. Patients were monitored using frequent clinical and laboratory examinations, the expanded disability status scale (EDSS), and brain magnetic resonance imaging (MRI).

Results: Two patients withdrew because of symptomatic hypercalcaemia (serum calcium >3.35 mmol/l in each case) resulting from persistent dietary indiscretion. Two diet compliant patients required temporary dose adjustments for mild asymptomatic hypercalcaemia. Diet compliant patients experienced mild adverse effects. The on-study exacerbation rate (27%) was less than baseline. Four patients experienced five clinical relapses but only one patient worsened by >1 EDSS point. Brain MRI revealed enhancing lesions in five patients at baseline (33%) and in four (29%) at both 24 and 48 weeks.

Conclusions: Oral calcitriol is safe and well tolerated for up to one year by diet compliant relapsing–remitting MS patients. Further study of vitamin D related mechanisms is warranted in MS.

Abbreviations: EDSS, expanded disability status scale; MS, multiple sclerosis

Keywords: multiple sclerosis; calcitriol; clinical trial

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