Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials

Thorax
Q1
Jan 2019
Citations:176
Influential Citations:4
Systematic Reviews / Meta-Analyses
85
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Enhanced Details

Methods
Three double-blind, placebo-controlled randomized trials in COPD patients; total randomized 560; ages 40–86; 315/472 (66.7%) were men; 458/472 (97.0%) were white European.
Intervention
Oral vitamin D3 regimens across trials: (1) 12 monthly bolus doses of 100,000 IU over 12 months (total 1,200,000 IU); (2) six bolus doses of 120,000 IU every two months over 12 months (total 720,000 IU); (3) daily 1,200 IU for 6 months (total 220,000 IU).
Results
Vitamin D3 supplementation did not reduce the overall rate of moderate/severe COPD exacerbations (adjusted IRR 0.94; 95% CI 0.78–1.13). In participants with baseline 25(OH)D <25 nmol/L, the rate was reduced (IRR 0.55; 95% CI 0.36–0.84). In those with baseline 25(OH)D ≥25 nmol/L, no reduction (IRR 1.04; 95% CI 0.85–1.27). Safety: no increase in serious adverse events or renal stones. Practical implication: test vitamin D status in COPD patients with exacerbations and provide supplementation to those with 25(OH)D <25 nmol/L to lower exacerbation risk.
Limitations
Only 3 of 4 eligible RCTs contributed IPD; one trial with 88 participants could not be included; limited power for subgroups; variability in dosing regimens; unable to formally assess publication bias; limited diversity (predominantly white European participants).

Abstract

Background Randomised controlled trials (RCTs) of vitamin D to prevent COPD exacerbations have yielded conflicting results. Individual participant data meta-analysis could identify factors that explain this variation. Methods PubMed, Embase, the Coch...