MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Several strands of evidence have indicated that vitamin D supplementation might be helpful for COVID-19 infections. Now we also have a study testing whether it works.

Spanish researchers evaluated the effect of calcifediol treatment on Intensive Care Unit Admission and Mortality rate among patients hospitalized for COVID-19 in a randomized, double blind clinical trial. A total of 76 consecutive patients hospitalized with COVID-19 infection and clinical picture of acute respiratory infection (confirmed by a radiographic pattern of viral pneumonia and by a positive SARS-CoV-2 PCR with CURB65 severity scale) were included. All patients received as best available therapy the same standard care. This consisted of a combination of:

  • hydroxychloroquine (400 mg every 12 h on the first day, and 200 mg every 12 h for the following 5 days),
  • azithromycin (500 mg orally for 5 days.

Eligible patients were allocated at a 2 calcifediol : 1 no calcifediol ratio through electronic randomization on the day of admission to take oral calcifediol (0.532 mg), or not. Patients in the calcifediol group continued with oral calcifediol (0.266 mg) on day 3 and 7, and then weekly until discharge or ICU admission. Outcomes of effectiveness included rate of ICU admission and deaths.

Of the 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50 %). Univariate Risk Estimate Odds Ratio for ICU in patients with Calcifediol treatment versus without Calcifediol treatment: 0.02 (95 %CI 0.002-0.17). Multivariate Risk Estimate Odds Ratio for ICU in patients with Calcifediol treatment vs Without Calcifediol treatment ICU (adjusting by Hypertension and T2DM): 0.03 (95 %CI: 0.003-0.25). Of the patients treated with calcifediol, none died, and all were discharged, without complications. The 13 patients not treated with calcifediol, who were not admitted to the ICU, were discharged. Of the 13 patients admitted to the ICU, two died and the remaining 11 were discharged.

The authors concluded as follows:

Our pilot study demonstrated that administration of calcifediol may improve the clinical outcome of subjects requiring hospitalization for COVID-19. Whether that would also apply to patients with an earlier stage of the disease and whether baseline vitamin D status modifies these results is unknown. Therefore, a multicenter randomized controlled trial using calcifediol, properly matched (Prevention and Treatment With Calcifediol of COVID-19 Induced Acute Respiratory Syndrome (COVIDIOL)), in 15 Spanish hospitals, funded by Clinical Research Program at COVID-19 “Progreso y Salud” Foundation and Foundation for Biomedical Research of Córdoba (FIBICO), Spain, (registered as NCT04366908 in NIH Trialnet database) will be carried out with the number of patients recalculated from the data provided by this study.

An interesting perspective of the new COVIDIOL trial with the recently available information, could be to evaluate calcifediol associated to dexamethasone or other corticoid vs. dexamethasone or other corticosteroid, since dexamethasone, which has potent anti-inflammatory actions, has recently been shown to reduce mortality in hospitalized patients on Covid-19 who are on respiratory assistance; so that treatment guidelines have been updated to recommend the use of glucocorticoids (including dexametasone), now proposed as the best available treatment in many hospitals around the world.

It is undeniable that this trial has several important limitations (and its authors are very honest to point them out). However, it is equally undeniable, in my view, that it is an important contribution to our current knowledge.

10 Responses to Vitamin D for COVID-19? Findings from a randomised trial are encouraging

  • That’s interesting. Another Vitamin D derivative, Calcipotriol, has been around for a while now, used for treating psoriasis, acting in complex immunological ways beyond my understanding.

  • It is just very pleasant to lie there in the early spring sunshine and feel the “warmth” of the sun on one’s skin, for the first time in months – it is not “evidence” of course but just a feeling of well being that lasts afterwards, how the skin feels and the faint pleasant smell too – and all for just ten minutes of dilute spring sunshine per side. Even if there were no beneficial effects at all, there is the mental effect.

    This is one unanticipated knock on effect of lockdown: less folks get D3.

  • Very interesting, indeed. I have always thought that vitamin deficiencies could be important in Covid-19 just as many other diseases. Just not a miracle cure.

    From a personal point of view, as an older Canadian[1] my doctor has me on a Vit-D supplement anyway. I feel better already.

    1. Many Canadians in winter look like a modern version of an Egyptian mummy. We do not get a lot of sunshine.

  • The topic „Vitamin D and COVID-19“ is discussed by Dr. Daniel Griffin and Prof. Vincent Racaniello in the latest episode of the highly educational podcast “This Week in Virology”
    https://www.youtube.com/watch?v=RNRsI9p6M5U&list=PL55B28888146FAD78&index=1
    (minutes 18:28 to 29:45).

    The current bottom line seems to be: “The jury is still out”.
    It should be mentioned that it is possible (and quite dangerous) to overdose vitamin D, as Dr. Griffin points out, and both experts recommend being very cautious with it.

  • A trial using the same protocol is currently been submitted to the Lancet for information from a group in Barcelona.
    They had similar results.

    https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3771318

  • From here:
    https://orthomolecular.activehosted.com/index.php?action=social&chash=9dcb88e0137649590b755372b040afad.192&s=c37d13c3fb4c0b717a82180695cd928b

    This:
    quote
    “In this COVID-19 epidemic situation, the simple nutritional supplements that could prevent COVID-19, such as vitamin C, vitamin D, zinc, magnesium, and hydrogen peroxide sprays are looked upon by the medical establishment as being useless and are banned. This is also the case with social media who rely on “fact checkers” who have not been educated in nutrition.”
    end-of-quote

    • @OB

      So a Dr who put unevidenced woo before proven treatments, thereby putting his patients at risk, is kicked out of his job. Sounds good to me. What’s your problem with it?

      Of course, if you or he have some good evidence that vitamin C, vitamin D, zinc, magnesium, and hydrogen peroxide sprays can prevent COVID-19, lets see it. But you don’t. Because there isn’t any.

      So. We have a quack making dangerous, unevidenced assertions and getting his patients to take worthless supplements. In addition to losing his job, I hope complaints are made and that he gets struck off.

    • Old Bob,

      In this COVID-19 epidemic situation, the simple nutritional supplements that could prevent COVID-19, such as vitamin C, vitamin D, zinc, magnesium, and hydrogen peroxide sprays are looked upon by the medical establishment as being useless and are banned

      None of these are banned, nor are they looked upon as useless. However, as with all treatments, they cannot be recommended in the absence of evidence supporting their use.

      The Lancet paper that Owen Parry has linked to does support the use of high-dose Vitamin D in individuals admitted to Hospital with Covid-19. The doses used are pharmacological, not untritional. They are potentially toxic and the conclusions of the paper can only be applied to the specific situation investigated in this study. However, this does underline the importance of investigating the other potential roles of vitamin D, for instance whether regular intake (at a safe dose) can reduce the risk of contracting Covid-19.

      This is also the case with social media who rely on “fact checkers” who have not been educated in nutrition.

      There is a huge amount of nonsense talked about nutrition, particularly by so-called nutritionists. Unfortunately many people confuse nutritionists with dieticians, who are trained in nutrition, regulated and are an essential part of any medical service. It does not help that the terminology differs from country to country.

      • To quote comedian Dara O’Brean (on YouTube, and I am slightly paraphrasing) “Dietician is to Nutritionist as Dentist is to Toothiologist”.

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