Calcifediol Treatment and COVID-19–Related Outcomes

• Published in: The journal of clinical endocrinology and metabolism Vol. 106; no. 10; pp. e4017 - e4027
• Main Authors: Nogues, Xavier, Ovejero, Diana, Pineda-Moncusi, Marta, Bouillon, Roger, Arenas, Dolors, Pascual, Julio, Ribes, Anna, Guerri-Fernandez, Robert, Villar-Garcia, Judit, Rial, Abora, Gimenez-Argente, Carme, Cos, Maria Lourdes, Rodriguez-Morera, Jaime, Campodarve, Isabel, Quesada-Gomez, Jose Manuel, Garcia-Giralt, Natalia
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.10.2021
• Subjects: Alfacalcidol; Analysis; Calcifediol; Clinical; Health aspects; Mortality; Spain; United Kingdom; Vitamin D; United Kingdom; Spain
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/clinem/dgab405

Abstract Context COVID-19 is a major health problem because of saturation of intensive care units (ICU) and mortality. Vitamin D has emerged as a potential treatment able to reduce the disease severity. Objective This work aims to elucidate the effect of 25(OH)D3 (calcifediol) treatment on COVID-19–related outcomes. Methods This observational cohort study was conducted from March to May 2020, among patients admitted to COVID-19 wards of Hospital del Mar, Barcelona, Spain. A total of 930 patients with COVID-19 were included; 92 were excluded because of previous calcifediol intake. Of the remaining 838, a total of 447 received calcifediol (532 μg on day 1 plus 266 μg on days 3, 7, 15, and 30), whereas 391 were not treated at the time of hospital admission (intention-to-treat). Of the latter, 53 patients were treated later during ICU admission and were allocated in the treated group in a second analysis. In healthy individuals, calcifediol is about 3.2-fold more potent on a weight basis than cholecalciferol. Main outcome measures were ICU admission and mortality. Results ICU assistance was required by 102 (12.2%) participants. Out of 447 patients treated with calcifediol at admission, 20 (4.5%) required the ICU, compared to 82 (21%) out of 391 nontreated (P < .001). Logistic regression of calcifediol treatment on ICU admission, adjusted by age, sex, linearized 25-hydroxyvitamin D levels at baseline, and comorbidities showed that treated patients had a reduced risk of requiring the ICU (odds ratio [OR] 0.13; 95% CI 0.07-0.23). Overall mortality was 10%. In the intention-to-treat analysis, 21 (4.7%) out of 447 patients treated with calcifediol at admission died compared to 62 patients (15.9%) out of 391 nontreated (P = .001). Adjusted results showed a reduced mortality risk with an OR of 0.21 (95% CI, 0.10-0.43). In the second analysis, the obtained OR was 0.52 (95% CI, 0.27-0.99). Conclusion In patients hospitalized with COVID-19, calcifediol treatment significantly reduced ICU admission and mortality.