P-112 Evaluation of Vitamin D Supplementation in Moderate to Severe Crohn's Disease Patients Using Anti-TNF: Replacement or Immunomodulation?

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Abstract

Background:

Background: Vitamin D (VD) deficiency is common in patients with Crohn's disease (CD). It is believed that this deficiency is related to the CD activity. However, the role of VD as a cause or consequence this condition is still unclear. There is no consensus in the literature regarding the best dosage for replacement, or even if there is evidence of immunomodulatory activity of VD in CD.

Aims:

To evaluate the results of the VD replacement at different doses and check possible immunomodulatory action of vitamin D in patients with CD

Methods:

Methods: We conducted a double-blind, randomized, prospective study. Forty-two patients were selected with history of moderate to severe CD in use of anti-TNF, of both sexes, between 18 to 60 years, with dosage of 25-hydroxyvitamin D <75 nmol/L (30 ng/mL) who signed the informed consent. Were excluded patients with less than 18 or over 60 years of age, pregnant women, chronic kidney or liver disease, sarcoidosis, tuberculosis, hyper- or hypoparathyroidism, neoplasias, use of anticonvulsants; and patients who received calcium supplements or VD in the last 6 months. Thirty patients were randomized. Patients were submitted to a questionnaire of sun exposure, quality of life (IBDQ), clinical examination, VD, C-reactive protein (CRP), fecal calprotectin (FC) dosage and were divided into 3 groups: 1 Group (G1): 10 patients receiving 2.000 U/VD, P.O./week for 8 weeks; 2 Group (G2): 10 patients receiving 10.000 U/VD, P.O./week for 8 weeks; 3 Group (G3): 10 patients receiving 50.000 U/VD, P.O./week for 8 weeks. At the end of 8 weeks the patients answered again IBDQ and were submited to VD, FC and CRP dosage.

Results:

IBDQ improvement was observed in all groups with statistically significant results in G2 (P = 0.04) and G3 (P = 0.01). Increased VD were observed in all groups (mean ± SD × mean ± SD): G1—(19.5 ± 5.1 × 26 ± 6.7) P = 0.07; G2—(19.1 ± 4.1 × 26 ± 5.8) P = 0.04; G3—19.5 ± 6.4 × 46.4 ± 12.7) P < 0.0001. CRP dosage were reduced, although not statistically significant, at G2 and G3 (5.8 ± 4 × 3 9 ± 2.8) P = 0.18 (5.2 ± 7.3 × 2.4 ± 3.6) P = 0.2; and increased in G1 (8.1 ± 10.3 × 13.4 ± 19.9) P = 0.3. There was a significant decrease in FC in G3 (1014 ± 850 × 483 ± 564) P = 0.04, no significant decrease in G2 (767 ± 751 ± 823 × 535) P = 0.2, and increase in G1 (1101 ± 744 × 1357 ± 819) P = 0.4.

Conclusions:

50.000 U/wk was the best dosage for VD replacement and is related to immunomodulation in patients with moderate to severe CD in use of anti-TNF.

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