Vitamin D for COVID-19: Are we missing a potential therapeutic?

Allow me to start off with a disclaimer. I favor cheap and readily available therapies over expensive therapeutics. There has been a lot of talk about Vitamin D and it’s relationship with COVID-19. Honestly too much for me to get into. It seems as if there’s something new every day. What we lack, though, is a body of evidence of any kind that looks at whether supplementing vitamin D in COVID patients is beneficial and improves outcomes. I have to tip my hat to Dr. Jose Dionisio Torres Jr, aka @sangrialovingairwaydoc who was the person who sent me this paper that has August 24th 2020 as its publication date. If you are interested in learning about Vitamin D supplementation in the Critically Ill: CLICK HERE.

A quick word on Impact Factor

I am not trying to be a snob, but I’ve been digging around a number of different journals over the last several years creating this page and my other social media ventures. If you’ve been around the block a couple times, you start learning about the heavy hitters in evidence-based medicine like the Lancet, New England Journal of Medicine, and Nature. You familiarize yourself with something called impact factor.

Impact factor has many limitations but generally speaking, the higher the better. That doesn’t mean that these journals are perfect given that NEJM and the Lancet have published a couple turd-sandwiches this year, but it gives you a general idea. A red flag when reviewing today’s article is that it was published in a journal named “The Journal of Steroid Biochemistry and Molecular Biology”. To be honest I hadn’t heard of this journal. When I looked them up they had an impact factor of 3.8 which is by far not the best but definitely not the worst I’ve seen. This possibly means that they tried to get it published in other journals and were denied. I could absolutely be wrong.

What is a pilot study?

The authors admit immediately that this is a pilot study. A pilot study is used to assess whether a particular study can actually be completed, not to give you a sure thing answer. It’s designed to test the architecture for a larger clinical trial. In other words, can we actually pull off a larger study about this? Perhaps this may be a reason why it was published in said journal.

Why the interest in Vitamin D in COVID?

Here I recommend you read the introduction of the article. I do not want to copy/paste their work but cannot say it better myself. There have been numerous instances where there has been a correlation between vitamin D deficiency and poor outcomes. Causality has not been determined. Amongst the benefits, they describe the function of vitamin D in:

  • cooling down what we are calling the “cytokine storm”
  • affecting the renin‑angiotensin system
  • affecting neutrophil activity
  • epithelial repair stimulation
  • putting the brakes on increased coagulability

Vitamin D and other therapies given to these patients with COVID

Calcifediol (25-hydroxyvitamin D3) was the form provided to these patients. This was provided orally in capsules of 0.532mg on day 1, 0.266mg on day 3 and 7 until discharge or ICU admission. They enrolled 76 consecutive patients. All the patients also received hydroxychloroquine as well as azithromycin. There is no mention about the dates when this study took place as that would help us learn what was standard of care at that time. Also no mention of glucocorticoids. Vitamin D was provided compared to controls in a 2:1 ratio

A quick look at the patients enrolled

We need to remember that this is a pilot study and what that means. The two groups were not as evenly matched as we would expect in an actual trial. More hypertensives in the control, trend towards higher d-dimer in the control, trend towards more diabetics in the control arm.

The effects of Vitamin D supplementation in COVID

The authors found that out of 26 patients in the control arm, 13 required ICU admission. That’s 50% folks. Out of the patients in the treatment arm, 50 patients, only ONE required ICU admission. Is this a cure? Nope. We need to wait for more evidence and thankfully the Spaniards are hard at work with a multi center randomized controlled trial to give us a more concrete answer.

Castillo ME, Entrenas Costa LM, Vaquero Barrios JM, et al. “Effect of Calcifediol Treatment and best Available Therapy versus best Available Therapy on Intensive Care Unit Admission and Mortality Among Patients Hospitalized for COVID-19: A Pilot Randomized Clinical study” [published online ahead of print, 2020 Aug 29]. J Steroid Biochem Mol Biol. 2020;105751. doi:10.1016/j.jsbmb.2020.105751
Link to Abstract

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