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Eur Respir J. 2019 Feb 6. pii: 1802003. doi: 10.1183/13993003.02003-2018. [Epub ahead of print]

Adjunctive vitamin D in tuberculosis treatment: meta-analysis of individual participant data.

Author information

1
Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
2
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
3
School of Public Health, Aarhus University, Aarhus, Denmark.
4
Bandim Health Project, Statens Serum Institute, Bissau, Guinea-Bissau.
5
International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.
6
King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
7
Memorial University, St John's, Newfoundland, Canada.
8
Menzies School of Health Research, Darwin , Australia.
9
Emory University School of Medicine, Atlanta, Georgia, USA.

Abstract

BACKGROUND:

Randomised controlled trials (RCTs) of adjunctive vitamin D in pulmonary tuberculosis (PTB) treatment have yielded conflicting results. Individual participant data (IPD) meta-analysis could identify factors explaining this variation.

METHODS:

We meta-analysed IPD from RCTs of vitamin D in patients receiving antimicrobial therapy for PTB. Primary outcome was time to sputum culture conversion. Secondary outcomes were time to sputum smear conversion, mean 8-week weight and incidence of adverse events. Pre-specified sub-group analyses were done according to baseline vitamin D status, age, sex, drug-susceptibility, HIV status, extent of disease, and vitamin D receptor genotype.

RESULTS:

IPD were obtained for 1850 participants in 8 studies. Vitamin D did not influence time to sputum culture conversion overall (aHR 1.06, 95% CI 0.91-1.23), but it did accelerate sputum culture conversion in participants with multidrug-resistant PTB (aHR 13.44, 95% CI 2.96-60.90); no such effect was seen in those whose isolate was sensitive to rifampicin and/or isoniazid (aHR 1.02, 95% CI 0.88-1.19; Pinteraction=0.02). Vitamin D accelerated sputum smear conversion overall (aHR 1.15, 95% CI 1.01-1.31), but did not influence other secondary outcomes.

CONCLUSIONS:

Vitamin D did not influence time to sputum culture conversion overall, but it accelerated sputum culture conversion in patients with multidrug-resistant PTB.

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