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Low Serum Vitamin D During Remission Increases Risk of Clinical Relapse in Patients With Ulcerative Colitis

  • John Gubatan
    Correspondence
    Reprint requests Address requests for reprints to: John Gubatan, MD, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215. fax: (617) 667-8665.
    Affiliations
    Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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  • Shuji Mitsuhashi
    Affiliations
    Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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  • Talia Zenlea
    Affiliations
    Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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  • Laura Rosenberg
    Affiliations
    Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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  • Simon Robson
    Affiliations
    Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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  • Alan C. Moss
    Affiliations
    Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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      Background & Aims

      Vitamin D levels have been associated with disease activity in patients with ulcerative colitis (UC), but it is unclear whether they affect the risk of disease relapse. We sought to determine the association between baseline vitamin D levels during a period of clinical remission and risk of subsequent UC relapse.

      Methods

      We performed a physician-blinded prospective study of 70 patients with UC in clinical remission followed up after a surveillance colonoscopy at a tertiary academic medical center. Serum samples were collected at the time of colonoscopy and baseline endoscopic and histologic activity were determined. Levels of 25-hydroxy-vitamin D were measured using an enzyme-linked immunosorbent assay. The primary outcome was rate of clinical relapse, determined over 12 months.

      Results

      The mean baseline vitamin D level was lower among patients with relapse (29.5 ng/mL) than without (50.3 ng/mL) (P = .001). Remission vitamin D level (≤35 ng/mL) was associated with a risk of clinical relapse (odds ratio, 1.25; 95% confidence interval [CI], 1.01–1.56; P = .044) over 12 months, independent of endoscopic or histologic grade at enrollment. A receiver operating characteristic curve of vitamin D levels for the outcome of relapse had an area under the curve of 0.72; and a serum level of 35 ng/mL or less had a sensitivity of 70% (95% CI, 46%–88%) and a specificity of 74% (95% CI 57%–83%) for predicting risk of clinical relapse.

      Conclusions

      Serum levels of vitamin D of 35 ng/mL or less during periods of clinical remission increase the risk of UC relapse. Clinical trials to obtain vitamin D levels higher than this threshold should be considered.

      Keywords

      Abbreviations used in this paper:

      CI (confidence interval), IBD (inflammatory bowel disease), OR (odds ratio), SCCAI (Simple Colitis Clinical Activity Index), UC (ulcerative colitis), VDR (vitamin D receptor)
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      Linked Article

      • Serum Vitamin D and Risk of Clinical Relapse in Patients With Ulcerative Colitis
        Clinical Gastroenterology and HepatologyVol. 15Issue 7
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          We read with interest the article by Gubatan and et al,1 who reported that serum 25-hydroxy vitamin D (25(OH)D) level less than 35 ng/mL (87.5 nmol/L) is associated with histologic remission at baseline and predicts risk of clinical relapse in patients with inflammatory bowel disease during the subsequent 12 months. As pointed out in a subsequent editorial by Hanauer,2 however, there was no clear linear dose-response relationship between serum 25(OH)D levels and risk of relapse. Other studies have previously reported inverse relationships between serum vitamin D status and objective markers of disease activity and a potential threshold effect at serum 25(OH)D of 100 nmol/L (40 ng/mL).
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