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The effect of 1-hydroxy-vitamin D treatment in hospitalized patients with COVID-19: A retrospective study

Ogasawara et al., Clinical Nutrition, doi:10.1016/j.clnu.2023.08.021
Sep 2023  
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Mortality 67% Improvement Relative Risk Progression 78% primary Oxygen therapy 75% Vitamin D  Ogasawara et al.  LATE TREATMENT Is late treatment with vitamin D beneficial for COVID-19? Retrospective 312 patients in Japan (April 2021 - September 2022) Lower progression (p=0.052) and lower oxygen therapy (p=0.093), not sig. c19early.org Ogasawara et al., Clinical Nutrition, Sep 2023 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.
4,500+ studies for 81 treatments. c19early.org
PSM retrospective 312 hospitalized patients in Japan, showing lower progression with vitamin D (alfacalcidol) treatment, statistically significant via KM log-rank.
Meta analysis shows that late stage treatment with calcitriol / calcifediol (or paricalcitol, alfacalcidol, etc.) is more effective than cholecalciferol: 69% [47‑82%] lower risk vs. 39% [27‑49%] lower risk. Cholecalciferol requires two hydroxylation steps to become activated - first in the liver to calcifediol, then in the kidney to calcitriol. Calcitriol, paricalcitol, and alfacalcidol are active vitamin D analogs that do not require conversion. This allows them to have more rapid onset of action compared to cholecalciferol. The time delay for cholecalciferol to increase serum calcifediol levels can be 2-3 days, and the delay for converting calcifediol to active calcitriol can be up to 7 days.
This is the 116th 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, 66.7% lower, RR 0.33, p = 1.00, treatment 0 of 54 (0.0%), control 1 of 54 (1.9%), NNT 54, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of progression, 77.8% lower, RR 0.22, p = 0.05, treatment 2 of 54 (3.7%), control 9 of 54 (16.7%), NNT 7.7, high-flow oxygen, mechanical ventilation, or mortality, primary outcome.
risk of oxygen therapy, 75.0% lower, RR 0.25, p = 0.09, treatment 2 of 54 (3.7%), control 8 of 54 (14.8%), NNT 9.0.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ogasawara et al., 1 Sep 2023, retrospective, Japan, peer-reviewed, 10 authors, study period April 2021 - September 2022, dosage alfacalcidol 1μg days 1-8, median duration, alfacalcidol and eldecalcitol used. Contact: shikatarawasagao@gmail.com.
This PaperVitamin DAll
The effect of 1-hydroxy-vitamin D treatment in hospitalized patients with COVID-19: A retrospective study
Takashi Ogasawara, Yasuhisa Tajima, Naoto Nakamura, Hiroki Kanasaki, Wataru Matsuyama, Mitsuru Niwa, Yuichi Ozawa, Masayuki Sugiura, Masahito Ogiku, Jun Sato
Clinical Nutrition, doi:10.1016/j.clnu.2023.08.021
Background & aims: The efficacy of vitamin D supplementation in coronavirus disease 2019 remains unclear. This study aimed to evaluate the effect of 1-hydroxy-vitamin D on the prevention of severe disease and mortality in patients hospitalized for COVID-19. Methods: This retrospective study included 312 patients with COVID-19 who were admitted to our hospital between April 2021 and October 2021 (primarily the Delta variant) and between July 2022 and September 2022 (primarily Omicron variant). Serum 25-hydroxyvitamin D (25(OH)D) levels were measured at the time of admission and 1-hydroxy-vitamin D was prescribed by the treating physicians. The patients were divided into two groups: those administered 1-hydroxy-vitamin D (Vit D group) and those who were not (control group). The composite primary endpoint was the need for additional respiratory support, including high-flow oxygen therapy or invasive mechanical ventilation, and in-hospital mortality rate. Results: Of 312 patients, 122 (39%) received 1-hydroxy-vitamin D treatment. Although the median age was not significantly higher in the Vit D group than in the control group (66 vs. 58 years old, P ¼ 0.06) and there was no significant difference in the proportion of vitamin D deficiency (defined as serum 25(OH)D level less than 20 ng/mL, 77% vs. 65%, P ¼ 0.07), patients in the control group had a more severe baseline profile compared to the Vit D group according to the Japanese disease severity definition for COVID-19 (P ¼ 0.01). The proportion of those requiring more respiratory support and in-hospital mortality was significantly lower in the Vit D group than in the control group (6% vs. 14%, P ¼ 0.01 log-rank test). After propensity score matching, a statistically significant difference in the primary endpoint was observed (P ¼ 0.03 log-rank test). Conclusions: 1-hydroxy-vitamin treatment may improve outcomes in hospitalized patients with COVID-19, reducing composite outcomes including the need for additional respiratory support and in-hospital mortality.
Author contributions TO and YT conceived and designed this study. TO, YT, NN, HK, YO, MS, MN and WM did acquisition, analyses, and interpretation of data. TO drafted manuscript. TO, YT, NN, WM, MN, MO and JS contributed to reviewing or revising the paper. All authors read and approved the final manuscript. Conflicts of interest None of the authors declared a conflict of interest.
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Late treatment
is less effective
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