Vitamin D supplementation to prevent asthma exacerbations: a systematic review and meta-analysis of individual participant data
Jolliffe DA, Greenberg L, Hooper RL, Griffiths CJ, Camargo CA, Kerley CP, Jensen ME, Mauger D, Stelmach I, Urashima M, Martineau AR
The Lancet. Respiratory medicine · 225 citas
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
- Universidad u hospital
- Queen Mary University of London
- Gobierno
- National Institute for Health and Care Research
- Universidad u hospital
- Jikei University School of Medicine
- Gobierno
- National Institutes of Health
- Gobierno
- National Heart, Lung, and Blood Institute
- Gobierno
- National Institute for Health Research (NIHR)
- Gobierno
- Medical Research Council
- Gobierno
- NHLBI NIH HHS
- Subvenciones
- National Institute for Health and Care Research (RP-PG-0407-10398); National Institute for Health and Care Research (13/03/25); National Heart, Lung, and Blood Institute (U10HL098115); National Institute for Health and Care Research (HTA/13/03/25); National Heart, Lung, and Blood Institute (U10HL064313)
Según 8 financiadores declarados.
Publicación
- Publicado
- 2017-10-05 · Lancet Respir Med · vol. 5 · número 11 · págs. 881–890
- Editorial
- Elsevier BV
- Citado
- 343 citas · más que el 99% de estudios similares · 8.0× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 34 trabajos
- Acceso
- Acceso abierto (copia en repositorio)
- Áreas de investigación
- Vitamin D Research Studies · Asthma and respiratory diseases · Antioxidant Activity and Oxidative Stress
- Palabras clave
- vitamin D supplementation, asthma exacerbations, systemic corticosteroids, 25-hydroxyvitamin D, vitamin D status, vitamin D3, vitamin D2, subgroup analysis, inhaled corticosteroids, time to first exacerbation, vitamin D deficiency, body mass index
- MeSH
- humans, asthma, disease progression, adrenal cortex hormones, vitamins, vitamin d, anti-asthmatic agents, treatment outcome, dietary supplements, adolescent, adult, aged, aged, 80 and over, middle aged, child, child, preschool, female, male, secondary prevention, young adult
11 autores
- David A. Jolliffe🇬🇧Queen Mary University of London; Blizard Institute
- Lauren Greenberg🇬🇧Queen Mary University of London; Blizard Institute
- Richard Hooper🇬🇧Queen Mary University of London; Blizard Institute
- Chris Griffiths🇬🇧Queen Mary University of London; Blizard Institute
- Carlos A. Camargo🇺🇸Harvard University; Massachusetts General Hospital
- Conor P. Kerley🇮🇪Dublin City University
- Megan E. Jensen🇦🇺University of Newcastle Australia
- David T. Mauger🇺🇸Pennsylvania State University
- Iwona Stelmach🇵🇱Medical University of Lodz
- Mitsuyoshi Urashima🇯🇵Jikei University School of Medicine
- Adrian R. Martineau🇬🇧 · autor de correspondenciaQueen Mary University of London; Blizard Institute
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
A previous aggregate data meta-analysis of randomised controlled trials showed that vitamin D supplementation reduces the rate of asthma exacerbations requiring treatment with systemic corticosteroids. Whether this effect is restricted to patients with low baseline vitamin D status is unknown.
Methods
For this systematic review and one-step and two-step meta-analysis of individual participant data, we searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science for double-blind, placebo-controlled, randomised controlled trials of vitamin D3 or vitamin D2 supplementation in people with asthma that reported incidence of asthma exacerbation, published between database inception and Oct 26, 2016. We analysed individual participant data requested from the principal investigator for each eligible trial, adjusting for age and sex, and clustering by study. The primary outcome was the incidence of asthma exacerbation requiring treatment with systemic corticosteroids. Mixed-effects regression models were used to obtain the pooled intervention effect with a 95% CI. Subgroup analyses were done to determine whether effects of vitamin D on risk of asthma exacerbation varied according to baseline 25-hydroxyvitamin D (25[OH]D) concentration, age, ethnic or racial origin, body-mass index, vitamin D dosing regimen, use of inhaled corticosteroids, or end-study 25(OH)D levels; post-hoc subgroup analyses were done according to sex and study duration. This study was registered with PROSPERO, number CRD42014013953.
Findings
Our search identified 483 unique studies, eight of which were eligible randomised controlled trials (total 1078 participants). We sought individual participant data for each and obtained it for seven studies (955 participants). Vitamin D supplementation reduced the rate of asthma exacerbation requiring treatment with systemic corticosteroids among all participants (adjusted incidence rate ratio [aIRR] 0·74, 95% CI 0·56-0·97; p=0·03; 955 participants in seven studies; high-quality evidence). There were no significant differences between vitamin D and placebo in the proportion of participants with at least one exacerbation or time to first exacerbation. Subgroup analyses of the rate of asthma exacerbations treated with systemic corticosteroids revealed that protective effects were seen in participants with baseline 25(OH)D of less than 25 nmol/L (aIRR 0·33, 0·11-0·98; p=0·046; 92 participants in three studies; moderate-quality evidence) but not in participants with higher baseline 25(OH)D levels (aIRR 0·77, 0·58-1·03; p=0·08; 764 participants in six studies; moderate-quality evidence; pinteraction=0·25). p values for interaction for all other subgroup analyses were also higher than 0·05; therefore, we did not show that the effects of this intervention are stronger in any one subgroup than in another. Six studies were assessed as being at low risk of bias, and one was assessed as being at unclear risk of bias. The two-step meta-analysis did not reveal evidence of heterogeneity of effect (I2=0·0, p=0·56).
Interpretation
Vitamin D supplementation reduced the rate of asthma exacerbations requiring treatment with systemic corticosteroids overall. We did not find definitive evidence that effects of this intervention differed across subgroups of patients.
Funding
Health Technology Assessment Program, National Institute for Health Research (reference number 13/03/25).
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial.
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