#283 COVID-19 and Vitamin D: Partners in Crime, or Simply Associates?
CLINICAL QUESTION
Does Vitamin D help prevent or treat COVID19?
BOTTOM LINE
While observational evidence suggests an association between low vitamin D levels and COVID-19 infection, it is unclear if this is simply reflective of overall health status. There are no randomized, controlled trials (RCTs) assessing vitamin D for prevention of COVID-19 infections. The highest quality RCT of vitamin D treatment during hospitalization did not demonstrate benefit for clinical outcomes.
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EVIDENCE
3 RCTs assessed treatment in hospitalized patients with COVID-19, all received standard care in addition to oral:
- Cholecalciferol 200,000 IU once versus placebo (240 patients, unpublished preprint).1
- No difference in length of stay (both 7 days).
- No difference mortality, ICU admission or ventilation.
- Calcifediol (~21,000 IU) on day 1, (~10,000 IU) days 3 and 7, then once weekly versus usual care (76 patients, pilot study). Study length not reported.2
- Vitamin D group showed:
- Significant reduction ICU admission 1/50 (2%) versus 13/26 (50%).
- Mortality 0/50 versus 2/26 (8%), not statistically different.
- Limitations: Unbalanced randomization (more diabetes and hypertension in control), patients and physicians not blinded.
- Vitamin D group showed:
- Cholecalciferol 60,000 IU daily x 7 days versus placebo in 40 patients with mild or no COVID-19 symptoms and Vitamin D deficient [25(OH) D <20ng/ml].3
- Significantly more patients tested negative for COVID-19 within 21 days with vitamin D supplementation.
- Limitations: Unclear randomization concealment and blinding, clinical outcomes not reported.
- There are no published RCTs evaluating the use of Vitamin D for prevention of COVID-19.
- Systematic reviews of observational studies generally demonstrate an association of low Vitamin D levels with COVID-19 infection and severity of infection, although included studies are often at high risk of bias.4-6
- Low vitamin D is associated with poor health7 and it is unclear if low vitamin D levels are causative or simply reflect health status.
- Additional confounders linked to COVID-19 severity and low vitamin D levels7 include higher body mass index, diabetes, older age, and Black race/ethnicity (versus non-Hispanic white).8
- Current guidelines recommend against Vitamin D supplementation solely for prevention or treatment of COVID-19.9
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