sreeram v.ramagopalan

Multiple sclerosis (MS) is an inflammatory disease while there are controversies regarding the role of vitamin D supplements in controlling relapse and disability improvement during treatment.

The goal of this systematic review and meta‑analysis was to evaluate the effect of vitamin D supplements on MS‑related relapse and the Expanded Disability Status Scale (EDSS).

We searched databases to include randomized clinical trials (RCTs) which were published up to October 2018. We included RCTs, being single‑blinded or double‑blinded or open‑label trials in which one of the main outcomes was EDSS and/or relapse after vitamin D supplementation. All statistical analyses were performed using RevMan 5.3. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for relapse between treatment arms. The mean difference was calculated for EDSS comparisons.

Nine articles were included for analysis. Of these nine studies, five compared vitamin D supplement groups with placebo (group 1 studies), and four compared high‑ and low‑dose vitamin D groups. A total of 561 patients were analyzed. Being treated with vitamin D instead of placebo showed no effect on relapse rate (OR = 0.66, 95% CI = 0.28–1.54) as well as EDSS (mean difference = 0.06, 95%CI [‑0.31, 0.42]). The results of studies comparing high‑ vs. low‑dose vitamin D interventions showed no significant effect on relapse rate (OR = 1.08, 95%CI [0.29–4.08] as well as final EDSS (mean difference = 0.17, 95% CI = ‑0.73, 1.07).

Our findings show that vitamin D supplements (high or low dose) have no significant effect on relapse rate and disability during treatment in MS patients.

Coronavirus disease 2019 (COVID-19) has become a pandemic, and patients receiving immunosuppressive agents could be at a higher risk of the infection. Patients’ knowledge and behavior play a major role in their health. Physicians should provide patients with enough information regarding medication use, prevention strategies, and treatment choices in case of infection.

This study aimed to evaluate the attitude and knowledge of Iranian patients with multiple sclerosis (MS) about COVID-19, as provided by physicians.

A google form was designed, and the patients consented to fill out the survey. The participants’ basic characteristics were collected. Moreover, they were asked about COVID-19 transmission routes and prevention strategies, their concerns regarding MS-related checkups during the COVID-19 pandemic, COVID-19 infection tests, COVID-19 symptoms, and information they received from their physicians about what to do in case of COVID-19 infection.

Four hundred and ten forms were collected. The mean age of the patients and the mean duration of the disease were 34.5 ± 8 and 7.2 ± 5.7 years, respectively. Nearly 80% of the respondents believed that patients with MS were at a higher risk of COVID-19 infection, and 75% of them thought that wearing a face mask could prevent the infection transmission. Moreover, only 21% of 410 the physicians informed their patients of when to stop their medication if they were suspected to have COVID-19, and 22% of them informed their patients of where to refer in case of COVID-19 suspicion. Nearly half of all physicians prescribed immune-boosting supplements, such as selenium, zinc, and vitamin D.

The results showed that Iranian MS patients had good knowledge regarding COVID-19 prevention strategies and transmission routes. However, they received less information from their physicians regarding medication use control, centers for admission, and physician consultation in case of COVID-19 infection.