Adjunctive vitamin D in tuberculosis treatment: meta-analysis of individual participant data. Issue 3 (7th March 2019)

• Record Type: Journal Article
• Authors: Jolliffe, David A.; Ganmaa, Davaasambuu; Wejse, Christian; Raqib, Rubhana; Haq, M. Ahsanul; Salahuddin, Nawal; Daley, Peter K.; Ralph, Anna P.; Ziegler, Thomas R.; Martineau, Adrian R.
• Is Part Of: European respiratory journal. Volume 53:Issue 3(2019)
• Publication Date: 2019-03-07
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.02003-2018
• Languages: English
• ISSNs: 0903-1936

Abstract

Background: Randomised controlled trials of adjunctive vitamin D in pulmonary tuberculosis (TB) treatment have yielded conflicting results. Individual participant data meta-analysis could identify factors explaining this variation. Methods: We meta-analysed individual participant data from randomised controlled trials of vitamin D in patients receiving antimicrobial therapy for pulmonary TB. 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 subgroup analyses were done according to baseline vitamin D status, age, sex, drug susceptibility, HIV status, extent of disease and vitamin D receptor genotype. Results: Individual participant data were obtained for 1850 participants in eight studies. Vitamin D did not influence time to sputum culture conversion overall (adjusted HR 1.06, 95% CI 0.91–1.23), but it did accelerate sputum culture conversion in participants with multidrug-resistant pulmonary TB (adjusted HR 13.44, 95% CI 2.96–60.90); no such effect was seen in those whose isolate was sensitive to rifampicin and/or isoniazid (adjusted HR 1.02, 95% CI 0.88–1.19; p-value for interaction=0.02). Vitamin D accelerated sputum smear conversion overall (adjusted HR 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 pulmonary TB. A meta-analysis of individual participant data from clinical trials reports that adjunctive vitamin D accelerates sputum culture conversion in patients with multidrug-resistant tuberculosis, but not in those with drug-sensitive disease http://ow.ly/f2oN30n2OxJ