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Published in: Trials 1/2012

Open Access 01-12-2012 | Study protocol

Efficacy of Vitamin D Supplementation in Multiple Sclerosis (EVIDIMS Trial): study protocol for a randomized controlled trial

Authors: Jan Dörr, Stephanie Ohlraun, Horst Skarabis, Friedemann Paul

Published in: Trials | Issue 1/2012

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Abstract

Background

Multiple sclerosis is the most common chronic inflammatory disease of the central nervous system in young adults. Despite the fact that numerous lines of evidence link both the risk of disease development and the disease course to the serum level of 25-hydroxyvitamin D it still remains elusive whether multiple sclerosis patients benefit from boosting the serum level of 25-hydroxyvitamin D, mainly because interventional clinical trials that directly address the therapeutic effects of vitamin D in multiple sclerosis are sparse. We here present the protocol of an interventional clinical phase II study to test the hypothesis, that high-dose vitamin D supplementation of multiple sclerosis patients is safe and superior to low-dose supplementation with respect to beneficial therapeutic effects.

Methods/Design

The EVIDIMS trial is a German multi-center, stratified, randomized, controlled and double-blind clinical phase II pilot study. Eighty patients with the diagnosis of definite multiple sclerosis or clinically isolated syndrome who are on a stable immunomodulatory treatment with interferon-β1b will be randomized to additionally receive either high-dose (average daily dose 10.200 IU) or low-dose (average daily dose 200 IU) cholecalciferol for a total period of 18 months. The primary outcome measure is the number of new lesions detected on T2-weighted cranial MRI at 3 tesla. Secondary endpoints include additional magnetic resonance imaging and optical coherence tomography parameters for neuroinflammation and -degeneration, clinical parameters for disease activity, as well as cognition, fatigue, depression, and quality of life. Safety and tolerability of high-dose vitamin D supplementation are further outcome parameters.

Discussion

In light of the discrepancy between existing epidemiological and preclinical data on the one hand and available clinical data on the other the EVIDIMS trial will substantially contribute to the evaluation of the efficacy of high-dose vitamin D supplementation in MS patients. The study design presented here fulfills the criteria of a high-quality clinical phase II trial in MS.

Trial Registration

ClinicalTrials.gov Identifier: NCT01440062
Literature
1.
go back to reference Compston A, Coles A: Multiple sclerosis. Lancet. 2008, 372: 1502-1517. 10.1016/S0140-6736(08)61620-7.CrossRefPubMed Compston A, Coles A: Multiple sclerosis. Lancet. 2008, 372: 1502-1517. 10.1016/S0140-6736(08)61620-7.CrossRefPubMed
2.
go back to reference Buck D, Hemmer B: Treatment of multiple sclerosis: current concepts and future perspectives. J Neurol. 2011, 258: 1747-1762. 10.1007/s00415-011-6101-2.CrossRefPubMed Buck D, Hemmer B: Treatment of multiple sclerosis: current concepts and future perspectives. J Neurol. 2011, 258: 1747-1762. 10.1007/s00415-011-6101-2.CrossRefPubMed
3.
go back to reference Río J, Comabella M, Montalban X: Multiple sclerosis: current treatment algorithms. Curr Opin Neurol. 2011, 24: 230-237. 10.1097/WCO.0b013e328346bf66.CrossRefPubMed Río J, Comabella M, Montalban X: Multiple sclerosis: current treatment algorithms. Curr Opin Neurol. 2011, 24: 230-237. 10.1097/WCO.0b013e328346bf66.CrossRefPubMed
4.
go back to reference Ascherio A, Munger KL, Simon KC: Vitamin D and multiple sclerosis. Lancet Neurol. 2010, 9: 599-612. 10.1016/S1474-4422(10)70086-7.CrossRefPubMed Ascherio A, Munger KL, Simon KC: Vitamin D and multiple sclerosis. Lancet Neurol. 2010, 9: 599-612. 10.1016/S1474-4422(10)70086-7.CrossRefPubMed
5.
go back to reference Kurtzke JF, Beebe GW, Norman JE: Epidemiology of multiple sclerosis in U.S. veterans: 1. Race, sex, and geographic distribution. Neurology. 1979, 29: 1228-1235.CrossRefPubMed Kurtzke JF, Beebe GW, Norman JE: Epidemiology of multiple sclerosis in U.S. veterans: 1. Race, sex, and geographic distribution. Neurology. 1979, 29: 1228-1235.CrossRefPubMed
6.
go back to reference van der Mei IAF, Ponsonby A-L, Dwyer T, Blizzard L, Simmons R, Taylor BV, Butzkueven H, Kilpatrick T: Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study. BMJ. 2003, 327: 316-10.1136/bmj.327.7410.316.CrossRefPubMedPubMedCentral van der Mei IAF, Ponsonby A-L, Dwyer T, Blizzard L, Simmons R, Taylor BV, Butzkueven H, Kilpatrick T: Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study. BMJ. 2003, 327: 316-10.1136/bmj.327.7410.316.CrossRefPubMedPubMedCentral
7.
go back to reference Handel AE, Giovannoni G, Ebers GC, Ramagopalan SV: Environmental factors and their timing in adult-onset multiple sclerosis. Nat Rev Neurol. 2010, 6: 156-166. 10.1038/nrneurol.2010.1.CrossRefPubMed Handel AE, Giovannoni G, Ebers GC, Ramagopalan SV: Environmental factors and their timing in adult-onset multiple sclerosis. Nat Rev Neurol. 2010, 6: 156-166. 10.1038/nrneurol.2010.1.CrossRefPubMed
8.
go back to reference Simpson S, Blizzard L, Otahal P, Van der Mei I, Taylor B: Latitude is significantly associated with the prevalence of multiple sclerosis: a meta-analysis. J Neurol Neurosurg Psychiatr. 2011, 82: 1132-1141. 10.1136/jnnp.2011.240432.CrossRefPubMed Simpson S, Blizzard L, Otahal P, Van der Mei I, Taylor B: Latitude is significantly associated with the prevalence of multiple sclerosis: a meta-analysis. J Neurol Neurosurg Psychiatr. 2011, 82: 1132-1141. 10.1136/jnnp.2011.240432.CrossRefPubMed
9.
go back to reference Islam T, Gauderman WJ, Cozen W, Mack TM: Childhood sun exposure influences risk of multiple sclerosis in monozygotic twins. Neurology. 2007, 69: 381-388. 10.1212/01.wnl.0000268266.50850.48.CrossRefPubMed Islam T, Gauderman WJ, Cozen W, Mack TM: Childhood sun exposure influences risk of multiple sclerosis in monozygotic twins. Neurology. 2007, 69: 381-388. 10.1212/01.wnl.0000268266.50850.48.CrossRefPubMed
10.
go back to reference Kampman MT, Wilsgaard T, Mellgren SI: Outdoor activities and diet in childhood and adolescence relate to MS risk above the Arctic Circle. J Neurol. 2007, 254: 471-477. 10.1007/s00415-006-0395-5.CrossRefPubMed Kampman MT, Wilsgaard T, Mellgren SI: Outdoor activities and diet in childhood and adolescence relate to MS risk above the Arctic Circle. J Neurol. 2007, 254: 471-477. 10.1007/s00415-006-0395-5.CrossRefPubMed
11.
go back to reference Dalmay F, Bhalla D, Nicoletti A, Cabrera-Gomez JA, Cabre P, Ruiz F, Druet-Cabanac M, Dumas M, Preux PM: Multiple sclerosis and solar exposure before the age of 15 years: case-control study in Cuba, Martinique and Sicily. Mult Scler. 2010, 16: 899-908. 10.1177/1352458510366856.CrossRefPubMed Dalmay F, Bhalla D, Nicoletti A, Cabrera-Gomez JA, Cabre P, Ruiz F, Druet-Cabanac M, Dumas M, Preux PM: Multiple sclerosis and solar exposure before the age of 15 years: case-control study in Cuba, Martinique and Sicily. Mult Scler. 2010, 16: 899-908. 10.1177/1352458510366856.CrossRefPubMed
12.
go back to reference Munger KL, Zhang SM, O'Reilly E, Hernán MA, Olek MJ, Willett WC, Ascherio A: Vitamin D intake and incidence of multiple sclerosis. Neurology. 2004, 62: 60-65.CrossRefPubMed Munger KL, Zhang SM, O'Reilly E, Hernán MA, Olek MJ, Willett WC, Ascherio A: Vitamin D intake and incidence of multiple sclerosis. Neurology. 2004, 62: 60-65.CrossRefPubMed
13.
go back to reference Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A: Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA. 2006, 296: 2832-2838. 10.1001/jama.296.23.2832.CrossRefPubMed Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A: Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA. 2006, 296: 2832-2838. 10.1001/jama.296.23.2832.CrossRefPubMed
14.
go back to reference Soilu-Hänninen M, Airas L, Mononen I, Heikkilä A, Viljanen M, Hänninen A: 25-Hydroxyvitamin D levels in serum at the onset of multiple sclerosis. Mult Scler. 2005, 11: 266-271. 10.1191/1352458505ms1157oa.CrossRefPubMed Soilu-Hänninen M, Airas L, Mononen I, Heikkilä A, Viljanen M, Hänninen A: 25-Hydroxyvitamin D levels in serum at the onset of multiple sclerosis. Mult Scler. 2005, 11: 266-271. 10.1191/1352458505ms1157oa.CrossRefPubMed
15.
go back to reference Simpson S, Taylor B, Blizzard L, Ponsonby A-L, Pittas F, Tremlett H, Dwyer T, Gies P, van der Mei I: Higher 25-hydroxyvitamin D is associated with lower relapse risk in multiple sclerosis. Ann Neurol. 2010, 68: 193-203.PubMed Simpson S, Taylor B, Blizzard L, Ponsonby A-L, Pittas F, Tremlett H, Dwyer T, Gies P, van der Mei I: Higher 25-hydroxyvitamin D is associated with lower relapse risk in multiple sclerosis. Ann Neurol. 2010, 68: 193-203.PubMed
16.
go back to reference Lemire JM, Archer DC: 1,25-dihydroxyvitamin D3 prevents the in vivo induction of murine experimental autoimmune encephalomyelitis. J Clin Invest. 1991, 87: 1103-1107. 10.1172/JCI115072.CrossRefPubMedPubMedCentral Lemire JM, Archer DC: 1,25-dihydroxyvitamin D3 prevents the in vivo induction of murine experimental autoimmune encephalomyelitis. J Clin Invest. 1991, 87: 1103-1107. 10.1172/JCI115072.CrossRefPubMedPubMedCentral
17.
go back to reference Cantorna MT, Hayes CE, DeLuca HF: 1,25-Dihydroxyvitamin D3 reversibly blocks the progression of relapsing encephalomyelitis, a model of multiple sclerosis. Proc Natl Acad Sci USA. 1996, 93: 7861-7864. 10.1073/pnas.93.15.7861.CrossRefPubMedPubMedCentral Cantorna MT, Hayes CE, DeLuca HF: 1,25-Dihydroxyvitamin D3 reversibly blocks the progression of relapsing encephalomyelitis, a model of multiple sclerosis. Proc Natl Acad Sci USA. 1996, 93: 7861-7864. 10.1073/pnas.93.15.7861.CrossRefPubMedPubMedCentral
18.
go back to reference van Etten E, Gysemans C, Branisteanu DD, Verstuyf A, Bouillon R, Overbergh L, Mathieu C: Novel insights in the immune function of the vitamin D system: Synergism with interferon-beta. The Journal of Steroid Biochemistry and Molecular Biology. 2007, 103: 546-551. 10.1016/j.jsbmb.2006.12.094.CrossRefPubMed van Etten E, Gysemans C, Branisteanu DD, Verstuyf A, Bouillon R, Overbergh L, Mathieu C: Novel insights in the immune function of the vitamin D system: Synergism with interferon-beta. The Journal of Steroid Biochemistry and Molecular Biology. 2007, 103: 546-551. 10.1016/j.jsbmb.2006.12.094.CrossRefPubMed
19.
go back to reference Pedersen LB, Nashold FE, Spach KM, Hayes CE: 1,25-dihydroxyvitamin D3 reverses experimental autoimmune encephalomyelitis by inhibiting chemokine synthesis and monocyte trafficking. J Neurosci Res. 2007, 85: 2480-2490. 10.1002/jnr.21382.CrossRefPubMed Pedersen LB, Nashold FE, Spach KM, Hayes CE: 1,25-dihydroxyvitamin D3 reverses experimental autoimmune encephalomyelitis by inhibiting chemokine synthesis and monocyte trafficking. J Neurosci Res. 2007, 85: 2480-2490. 10.1002/jnr.21382.CrossRefPubMed
20.
go back to reference Wergeland S, Torkildsen O, Myhr K-M, Aksnes L, Mørk SJ, Bø L: Dietary vitamin d3 supplements reduce demyelination in the cuprizone model. PLoS ONE. 2011, 6: e26262-10.1371/journal.pone.0026262.CrossRefPubMedPubMedCentral Wergeland S, Torkildsen O, Myhr K-M, Aksnes L, Mørk SJ, Bø L: Dietary vitamin d3 supplements reduce demyelination in the cuprizone model. PLoS ONE. 2011, 6: e26262-10.1371/journal.pone.0026262.CrossRefPubMedPubMedCentral
21.
go back to reference Kimball SM, Ursell MR, O'Connor P, Vieth R: Safety of vitamin D3 in adults with multiple sclerosis. Am J Clin Nutr. 2007, 86: 645-651.PubMed Kimball SM, Ursell MR, O'Connor P, Vieth R: Safety of vitamin D3 in adults with multiple sclerosis. Am J Clin Nutr. 2007, 86: 645-651.PubMed
22.
go back to reference Burton JM, Kimball S, Vieth R, Bar-Or A, Dosch H-M, Cheung R, Gagne D, D'Souza C, Ursell M, O'Connor P: A phase I/II dose-escalation trial of vitamin D3 and calcium in multiple sclerosis. Neurology. 2010, 74: 1852-1859. 10.1212/WNL.0b013e3181e1cec2.CrossRefPubMedPubMedCentral Burton JM, Kimball S, Vieth R, Bar-Or A, Dosch H-M, Cheung R, Gagne D, D'Souza C, Ursell M, O'Connor P: A phase I/II dose-escalation trial of vitamin D3 and calcium in multiple sclerosis. Neurology. 2010, 74: 1852-1859. 10.1212/WNL.0b013e3181e1cec2.CrossRefPubMedPubMedCentral
23.
go back to reference Hathcock JN, Shao A, Vieth R, Heaney R: Risk assessment for vitamin D. Am J Clin Nutr. 2007, 85: 6-18.PubMed Hathcock JN, Shao A, Vieth R, Heaney R: Risk assessment for vitamin D. Am J Clin Nutr. 2007, 85: 6-18.PubMed
24.
go back to reference Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B: Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006, 84: 18-28.PubMed Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B: Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006, 84: 18-28.PubMed
25.
go back to reference Goldberg P, Fleming MC, Picard EH: Multiple sclerosis: decreased relapse rate through dietary supplementation with calcium, magnesium and vitamin D. Med Hypotheses. 1986, 21: 193-200. 10.1016/0306-9877(86)90010-1.CrossRefPubMed Goldberg P, Fleming MC, Picard EH: Multiple sclerosis: decreased relapse rate through dietary supplementation with calcium, magnesium and vitamin D. Med Hypotheses. 1986, 21: 193-200. 10.1016/0306-9877(86)90010-1.CrossRefPubMed
26.
go back to reference Jagannath VA, Fedorowicz Z, Asokan GV, Robak EW, Whamond L: Vitamin D for the management of multiple sclerosis. Cochrane Database Syst Rev. 2010, CD008422- Jagannath VA, Fedorowicz Z, Asokan GV, Robak EW, Whamond L: Vitamin D for the management of multiple sclerosis. Cochrane Database Syst Rev. 2010, CD008422-
27.
go back to reference Moher D, Schulz KF, Altman DG: The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001, 1: 2-10.1186/1471-2288-1-2.CrossRefPubMedPubMedCentral Moher D, Schulz KF, Altman DG: The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001, 1: 2-10.1186/1471-2288-1-2.CrossRefPubMedPubMedCentral
28.
go back to reference Schulz KF, Altman DG, Moher D: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. Trials. 2010, 11: 32-10.1186/1745-6215-11-32.CrossRefPubMedPubMedCentral Schulz KF, Altman DG, Moher D: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. Trials. 2010, 11: 32-10.1186/1745-6215-11-32.CrossRefPubMedPubMedCentral
29.
go back to reference Polman CH, Reingold SC, Edan G, Filippi M, Hartung H-P, Kappos L, Lublin FD, Metz LM, McFarland HF, O'Connor PW, Sandberg-Wollheim M, Thompson AJ, Weinshenker BG, Wolinsky JS: Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria.". Ann Neurol. 2005, 58: 840-846. 10.1002/ana.20703.CrossRefPubMed Polman CH, Reingold SC, Edan G, Filippi M, Hartung H-P, Kappos L, Lublin FD, Metz LM, McFarland HF, O'Connor PW, Sandberg-Wollheim M, Thompson AJ, Weinshenker BG, Wolinsky JS: Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria.". Ann Neurol. 2005, 58: 840-846. 10.1002/ana.20703.CrossRefPubMed
30.
go back to reference Kurtzke JF: Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983, 33: 1444-1452.CrossRefPubMed Kurtzke JF: Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983, 33: 1444-1452.CrossRefPubMed
31.
go back to reference Bechtel N, Scahill RI, Rosas HD, Acharya T, van den Bogaard SJA, Jauffret C, Say MJ, Sturrock A, Johnson H, Onorato CE, Salat DH, Durr A, Leavitt BR, Roos RAC, Landwehrmeyer GB, Langbehn DR, Stout JC, Tabrizi SJ, Reilmann R: Tapping linked to function and structure in premanifest and symptomatic Huntington disease. Neurology. 2010, 75: 2150-2160. 10.1212/WNL.0b013e3182020123.CrossRefPubMedPubMedCentral Bechtel N, Scahill RI, Rosas HD, Acharya T, van den Bogaard SJA, Jauffret C, Say MJ, Sturrock A, Johnson H, Onorato CE, Salat DH, Durr A, Leavitt BR, Roos RAC, Landwehrmeyer GB, Langbehn DR, Stout JC, Tabrizi SJ, Reilmann R: Tapping linked to function and structure in premanifest and symptomatic Huntington disease. Neurology. 2010, 75: 2150-2160. 10.1212/WNL.0b013e3182020123.CrossRefPubMedPubMedCentral
32.
go back to reference Reilmann R, Bohlen S, Klopstock T, Bender A, Weindl A, Saemann P, Auer DP, Ringelstein EB, Lange HW: Grasping premanifest Huntington's disease - shaping new endpoints for new trials. Mov Disord. 2010, 25: 2858-2862. 10.1002/mds.23300.CrossRefPubMed Reilmann R, Bohlen S, Klopstock T, Bender A, Weindl A, Saemann P, Auer DP, Ringelstein EB, Lange HW: Grasping premanifest Huntington's disease - shaping new endpoints for new trials. Mov Disord. 2010, 25: 2858-2862. 10.1002/mds.23300.CrossRefPubMed
33.
go back to reference Petzold A, de Boer JF, Schippling S, Vermersch P, Kardon R, Green A, Calabresi PA, Polman C: Optical coherence tomography in multiple sclerosis: a systematic review and meta-analysis. Lancet Neurol. 2010, 9: 921-932. 10.1016/S1474-4422(10)70168-X.CrossRefPubMed Petzold A, de Boer JF, Schippling S, Vermersch P, Kardon R, Green A, Calabresi PA, Polman C: Optical coherence tomography in multiple sclerosis: a systematic review and meta-analysis. Lancet Neurol. 2010, 9: 921-932. 10.1016/S1474-4422(10)70168-X.CrossRefPubMed
34.
go back to reference Wingerchuk DM, Noseworthy JH: Randomized controlled trials to assess therapies for multiple sclerosis. Neurology. 2002, 58: S40-S48.CrossRefPubMed Wingerchuk DM, Noseworthy JH: Randomized controlled trials to assess therapies for multiple sclerosis. Neurology. 2002, 58: S40-S48.CrossRefPubMed
35.
go back to reference van der Mei IAF, Ponsonby A-L, Dwyer T, Blizzard L, Taylor BV, Kilpatrick T, Butzkueven H, McMichael AJ: Vitamin D levels in people with multiple sclerosis and community controls in Tasmania, Australia. J Neurol. 2007, 254: 581-590. 10.1007/s00415-006-0315-8.CrossRefPubMed van der Mei IAF, Ponsonby A-L, Dwyer T, Blizzard L, Taylor BV, Kilpatrick T, Butzkueven H, McMichael AJ: Vitamin D levels in people with multiple sclerosis and community controls in Tasmania, Australia. J Neurol. 2007, 254: 581-590. 10.1007/s00415-006-0315-8.CrossRefPubMed
36.
go back to reference Paty DW, Li DK, UBC MS/MRI Study Group, IFNB Multiple Sclerosis Study Group: Interferon beta-lb is effective in relapsing-remitting multiple sclerosis. II. MRI analysis results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology. 1993, 43: 662-667.CrossRefPubMed Paty DW, Li DK, UBC MS/MRI Study Group, IFNB Multiple Sclerosis Study Group: Interferon beta-lb is effective in relapsing-remitting multiple sclerosis. II. MRI analysis results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology. 1993, 43: 662-667.CrossRefPubMed
Metadata
Title
Efficacy of Vitamin D Supplementation in Multiple Sclerosis (EVIDIMS Trial): study protocol for a randomized controlled trial
Authors
Jan Dörr
Stephanie Ohlraun
Horst Skarabis
Friedemann Paul
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Trials / Issue 1/2012
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-13-15

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