Christian Wejse

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

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

DOI

  • David A. Jolliffe, Queen Mary University of London
  • ,
  • Davaasambuu Ganmaa, Harvard School of Public Health
  • ,
  • Christian Wejse
  • Rubhana Raqib, International Centre for Diarrhoeal Disease Research Bangladesh
  • ,
  • M. Ahsanul Haq, International Centre for Diarrhoeal Disease Research Bangladesh
  • ,
  • Nawal Salahuddin, King Faisal Specialist Hospital and Research Center
  • ,
  • Peter K. Daley, Memorial University of Newfoundland
  • ,
  • Anna P. Ralph, Menzies School of Health Research
  • ,
  • Thomas R. Ziegler, Emory University School of Medicine
  • ,
  • Adrian R. Martineau, Queen Mary University of London, Queen Mary University of London

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.

OriginalsprogEngelsk
Artikelnummer1802003
BogserieEuropean Respiratory Journal
Vol/bind53
Nummer3
ISSN0903-1936
DOI
StatusUdgivet - mar. 2019

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