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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.

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



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.


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.


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.


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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