Yatish Byndoor, Tamilisetti Vidya Sagar, Raju H Patil, Dakkumalla Veeraiah
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Yatish Byndoor1, Tamilisetti Vidya Sagar2, Raju H Patil3, Dakkumalla Veeraiah4
1Associate Professor, Department of Pharmacology, Apollo Institute of Medical Sciences and Research, Chittoor, AP, India.
2Associate Professor, Department of Pharmacology, GSL Medical College, Rajahmundry, India.
3Associate Professor, Department of Community Medicine, Varun Arjun Medical College and Rohilkhand Hospital, Banthra, UP.
4Assistant Professor, Department of Pharmacology, Rangaraya Medical College, Kakinada, AP.
Volume - 16,
Issue - 10,
Year - 2023
Objective: To compare vitamin D with placebo in patients with pulmonary tuberculosis in terms of clinical improvement and sputum conversion. Materials And Methods: This is a prospective randomized, double blind, placebo controlled comparative study conducted for a period of 12 weeks in a tertiary care centre in south India. Total Subjects were 60 new cases of pulmonary tuberculosis who are getting TB treatment initiation, Subjects were randomly allocated into two groups, group A and group B comprising of 30 patients in each group. Group A received vitamin D and group B received placebo. Dosage of vitamin D was 0.25mg/day, given in initial six weeks of antituberculosis drug therapy. Serum level of 25-hydroxyvitamin D was measured at time of diagnosis and at 8 weeks of anti-tuberculous therapy. Measurements of haemoglobin, leukocyte count and serum calcium were done at beginning and repeated at 6th, 8th and 12 weeks. Acid fast bacilli were examined at beginning and on 6th, 8thand 12 weeks. Primary outcome was evaluation of conversion time of sputum smear; secondary outcome was clinical improvement as assessed by TB score. Results: There is no significant difference in mean values of age, haemoglobin level, calcium level,serum Vitamin D, TB score and total lymphocyte count in both groups at start of study.There was no statistical difference in serum calcium level, haemoglobin level and total lymphocyte level at end of study. Mean serum vitamin D level at 8th week of treatment was 27.83±7.09ng/dl in group A and 18.83±2.27 in group B, there was statistically significant difference between two groups. Sixth week sputum conversion in 30 subjects of vitamin D group is 100% and in placebo group, it is 76.7%, which was statistically significant. Conclusion: Supplementary vitamin D when added to first line anti-tuberculous drugs results in shorter conversion time and less severe TB clinical manifestation without any manifestations of hypercalcemia. Therefore, it is recommended to add vitamin D as supplementary treatment to first-line anti-tuberculous drugs in treatment course of active pulmonary TB.
Cite this article:
Yatish Byndoor, Tamilisetti Vidya Sagar, Raju H Patil, Dakkumalla Veeraiah. Vitamin D as Supplementary Treatment for Newly Diagnosed Pulmonary Tuberculosis patients. Research Journal of Pharmacy and Technology 2023; 16(10):4924-8. doi: 10.52711/0974-360X.2023.00798
Yatish Byndoor, Tamilisetti Vidya Sagar, Raju H Patil, Dakkumalla Veeraiah. Vitamin D as Supplementary Treatment for Newly Diagnosed Pulmonary Tuberculosis patients. Research Journal of Pharmacy and Technology 2023; 16(10):4924-8. doi: 10.52711/0974-360X.2023.00798 Available on: https://rjptonline.org/AbstractView.aspx?PID=2023-16-10-68
1. Holick, Michael F. High prevalence of vitamin D inadequacy and implications for health. Mayo Clinic Proceedings. 2006; 81(3): 353-73. doi:10.4065/81.3.353
2. Talat, Najeeha et al. Vitamin D deficiency and tuberculosis progression. Emerging Infectious Diseases. 2010;16(5): 853-5. doi:10.3201/eid1605.091693
3. Sita-Lumsden, A et al. Reactivation of tuberculosis and vitamin D deficiency: the contribution of diet and exposure to sunlight. Thorax. 2007; 62(11): 1003-7. doi:10.1136/thx.2006.070060
4. Lemire, J M. Immunomodulatory role of 1,25-dihydroxyvitamin D3. Journal of Cellular Biochemistry. 1992; 49(1); 26-31. doi:10.1002/jcb.240490106
5. Bhalla, A K et al. Specific high-affinity receptors for 1,25-dihydroxyvitamin D3 in human peripheral blood mononuclear cells: presence in monocytes and induction in T lymphocytes following activation. The Journal of Clinical Endocrinology and Metabolism. 1983; 57(6): 1308-10. doi:10.1210/jcem-57-6-1308
6. Yim, Sunghan et al. Induction of cathelicidin in normal and CF bronchial epithelial cells by 1,25-dihydroxyvitamin D(3). Journal of cystic fibrosis: official Journal of the European Cystic Fibrosis Society. 2007; 6(6): 403-10. doi:10.1016/j.jcf.2007.03.003
7. Liu, Philip T et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science (New York, N.Y.). 2006; 311(5768): 1770-3. doi:10.1126/science.1123933
8. Martineau, Adrian R et al. IFN-gamma- and TNF-independent vitamin D-inducible human suppression of mycobacteria: the role of cathelicidin LL-37. Journal of Immunology (Baltimore, Md. : 1950). 2007; 178(11): 7190-8. doi:10.4049/jimmunol.178.11.7190
9. Coussens, Anna et al. 1alpha,25-dihydroxyvitamin D3 inhibits matrix metalloproteinases induced by Mycobacterium tuberculosis infection. Immunology. 2009; 127(4): 539-48. doi:10.1111/j.1365-2567.2008.03024.x
10. Bellamy, R. Evidence of gene-environment interaction in development of tuberculosis. Lancet (London, England). 2000; 355: 588-9. doi:10.1016/S0140-6736(99)00426-2
11. Zasloff, Michael. Fighting infections with vitamin D. Nature Medicine. 2006; 12(4): 388-90. doi:10.1038/nm0406-388
12. Martineau, Adrian R et al. Vitamin D in the treatment of pulmonary tuberculosis. The Journal of Steroid Biochemistry and Molecular Biology. 2007; 103(3-5): 793-8. doi:10.1016/j.jsbmb.2006.12.052
13. Vijay Jaimni, Barkur Ananthakrishna Shasty, Sharath P. Madhyastha, Ganesh V. Shetty, Raviraja V. Acharya, Ragini Bekur, Akhila Doddamani. Association of Vitamin D Deficiency and Newly Diagnosed Pulmonary Tuberculosis. Pulmonary Medicine. 2021; 6. https://doi.org/10.1155/2021/5285841
14. Payne, R B et al. Interpretation of serum calcium in patients with abnormal serum proteins. British Medical Journal. 1973; 4: 643-6. doi:10.1136/bmj.4.5893.643
15. Wejse, Christian et al. TB score: Signs and symptoms from tuberculosis patients in a low-resource setting have predictive value and may be used to assess clinical course. Scandinavian Journal of Infectious Diseases. 2008; 40(2): 111-20. doi:10.1080/00365540701558698
16. S. Kotz, N. Balakrishnan, C.B. Read, B. Vidakovic, Encyclopedia of statistical sciences, second ed., Wiley- Interscience, Hoboken, N.J., 2006.
17. Metcalfe, John Z et al. Interferon-γ release assays for active pulmonary tuberculosis diagnosis in adults in low- and middle-income countries: systematic review and meta-analysis. The Journal of Infectious Diseases. 2011; 204(4): S1120-9. doi:10.1093/infdis/jir410
18. Dye, Christopher. Global epidemiology of tuberculosis. Lancet (London, England). 2006; 367: 938-40. doi:10.1016/S0140-6736(06)68384-0
19. Seung, Kwonjune J et al. Multidrug-Resistant Tuberculosis and Extensively Drug-Resistant Tuberculosis. Cold Spring Harbor perspectives in medicine. 2015; 5(9): a017863. doi:10.1101/cshperspect.a017863
20. Ahmad, Suhail et al. Prevalence of tuberculosis and multidrug resistant tuberculosis in the Middle East Region. Expert Review of Anti-Infective Therapy. 2018; 16(9): 709-721. doi:10.1080/14787210.2018.1519393
21. World Health Organization (WHO), Global Tuberculosis Report 2012, WHO, Geneva, 2012.
22. Underner, Michel, and Jean Perriot. Tabac et tuberculose [Smoking and tuberculosis]. Presse medicale (Paris, France : 1983). 2012; 41(12): 1171-80. doi:10.1016/j.lpm.2012.02.037
23. Sita-Lumsden, A et al. Reactivation of tuberculosis and vitamin D deficiency: the contribution of diet and exposure to sunlight. Thorax. 2007; 62(11): 1003-7. doi:10.1136/thx.2006.070060
24. Janols, Helena et al. Early treatment response evaluated by a clinical scoring system correlates with the prognosis of pulmonary tuberculosis patients in Ethiopia: a prospective follow-up study. Scandinavian Journal of Infectious Diseases. 2012; 44(11): 828-34. doi:10.3109/00365548.2012.694468
25. Salahuddin, Nawal et al. Vitamin D accelerates clinical recovery from tuberculosis: results of the SUCCINCT Study [Supplementary Cholecalciferol in recovery from tuberculosis]. A randomized, placebo-controlled, clinical trial of vitamin D supplementation in patients with pulmonary tuberculosis. BMC Infectious Diseases. 2013; 13(22) doi:10.1186/1471-2334-13-22