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The Interaction of Vitamin D and Corticosteroids: A Mortality Analysis of 26,508 Veterans Who Tested Positive for SARS-CoV-2

Efird et al., International Journal of Environmental Research and Public Health, doi:10.3390/ijerph19010447
Dec 2021  
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Mortality 49% Improvement Relative Risk Mortality (b) 55% Vitamin D for COVID-19  Efird et al.  EARLY TREATMENT Is early treatment with vitamin D beneficial for COVID-19? Retrospective 16,338 patients in the USA (March - September 2020) Lower mortality with vitamin D (not stat. sig., p=0.1) Efird et al., Int. J. Environmental Re.., Dec 2021 Favorsvitamin D Favorscontrol 0 0.5 1 1.5 2+
Vitamin D for COVID-19
8th treatment shown to reduce risk in October 2020
*, now with p < 0.00000000001 from 122 studies, recognized in 9 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments.
Retrospective 26,508 COVID+ veterans in USA, showing lower mortality with vitamin D use after testing positive (defined as being administered ≥7 days or half of the survival time within 2 weeks after testing), with statistical significance for hospitalized patients.
This is the 64th of 122 COVID-19 controlled studies for vitamin D, which collectively show efficacy with p<0.0000000001 (1 in 587 sextillion).
30 studies are RCTs, which show efficacy with p=0.0000032.
risk of death, 48.9% lower, RR 0.51, p = 0.10, treatment 11 of 544 (2.0%), control 413 of 15,794 (2.6%), adjusted per study, non-hospitalized patients, vitamin D + no corticosteroids vs. no vitamin D + no corticosteroids.
risk of death, 54.5% lower, RR 0.45, p = 0.02, treatment 11 of 192 (5.7%), control 553 of 4,340 (12.7%), NNT 14, adjusted per study, hospitalized patients, vitamin D + no corticosteroids vs. no vitamin D + no corticosteroids.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Efird et al., 31 Dec 2021, retrospective, USA, peer-reviewed, 10 authors, study period 1 March, 2020 - 10 September, 2020, dosage varies.
This PaperVitamin DAll
The Interaction of Vitamin D and Corticosteroids: A Mortality Analysis of 26,508 Veterans Who Tested Positive for SARS-CoV-2
Jimmy T Efird, Ethan J Anderson, Charulata Jindal, Thomas S Redding, Andrew D Thompson, Ashlyn M Press, Julie Upchurch, Christina D Williams, Yuk Ming Choi, Ayako Suzuki
International Journal of Environmental Research and Public Health, doi:10.3390/ijerph19010447
This data-based cohort consisted of 26,508 (7%) United States veterans out of the 399,290 who tested positive for SARS-CoV-2 from 1 March to 10 September 2020. We aimed to assess the interaction of post-index vitamin D (Vit D) and corticosteroid (CRT) use on 30-day mortality among hospitalized and non-hospitalized patients with coronavirus disease 2019 (COVID-19). Combination Vit D and CRT drug use was assessed according to four multinomial pairs (−|+, −|−, +|+, +|−). Respective categorical effects were computed on a log-binomial scale as adjusted relative risk (aRR). Approximately 6% of veterans who tested positive for SARS-CoV-2 died within 30 days of their index date. Among hospitalized patients, a significantly decreased aRR was observed for the use of Vit D in the absence of CRTs relative to patients who received CRTs but not Vit D (aRR = 0.30; multiplicity corrected, p = 0.0004). Among patients receiving systemically administered CRTs (e.g., dexamethasone), the use of Vit D was associated with fewer deaths in hospitalized patients (aRR = 0.51) compared with non-hospitalized patients (aRR = 2.5) (P-for-Interaction = 0.0071). Evaluating the effect of modification of these compounds in the context of hospitalization may aid in the management of COVID-19 and provide a better understanding of the pathophysiological mechanisms underlying this and future infectious disease outbreaks.
Author Contributions: Conceptualization, J.T.E., A.S. and E.J.A.; data curation, T.S.R., A.D.T. and J.T.E.; formal analysis, J.T.E., T.S.R. and A.D.T.; funding acquisition, A.S.; methodology, J.T.E.; project administration, A.S., A.M.P. and J.U.; supervision, A.S. and J.T.E.; validation, A.D.T.; visualization, Conflicts of Interest: The authors declare no conflict of interest.
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