Ulcerative Colitis and Vitamin D Supplementation

University Hospital of North Norway

Overview

Ulcerative colitis (UC) is an inflammatory disease involving the colonic mucosa, with bleedings and ulcerations. Consequences are destroyed mucosal barrier and increased permeability. Several cytokines are described to mediate the progressive course of ulcerative colitis and it is considered nowadays an immunologic disease. Patients with UC have often low levels of vitamin D and elevated prevalence of osteoporosis. In vitro studies demonstrate that vitamin D has an immunomodulating effect, and may have a direct healing action on colonic mucosa has been described in animal studies. One can therefore rise a hypothesis that vitamin D supplementation could be crucial in patients with UC. To our knowledge, it has not been performed randomized clinical trials to study these possible effects of vitamin D and it has not been studied the effects of vitamin D on the relapse frequency and immunological composition of colic mucosa in patient with moderate to severe ulcerative colitis. Objectives for our study are as follows: To examine if high-dose vitamin D supplementation in patients with moderate to severe ulcerative colitis: * reduces relapse frequency and increase the duration of the Infliximab induced remission * mediates and changes the cytokines composition in the colic mucosa * decreases the excretion of calprotectin in feces and reduces the concentration of inflammation markers * augments bone mass

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Conditions

Ulcerative Colitis

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Men and women older than18 years old, diagnosed with UC (either debut or relapsed chronic UC), moderate or severe, where it is an indication to treat with infliximab. Exclusion Criteria: * Primary hyperparathyroidism (PHPT) * Sarcoidosis * Renal failure (serum creatinine \> 125 mumol/L in men or \> 105 mumol/L in women) * Those, who use solarium routinely are not included * Pregnant or breastfeeding women, otherwise women of fertile age must be on approved birth control methods during the study * Renal stones last 15 years * Cancer of any origin, diagnosed during last 5 years * Unstable angina pectoris

Outcomes

Primary Outcomes

number of patients with remission

Mandatory criterion of remission: clinical remission (defined as Mayo score \<= 1, including endoscopic findings) and non-mandatory: laboratory (calprotectin \< 100, WBC and SR within reference range). These criteria will be assessed at 12 month after the start of intervention

Time frame: 12 months after start of intervention

Secondary Outcomes

change in fecal calprotectin

change in fecal calprotectin compared to baseline value

Time frame: 12 months after start of intervention

change in bone mineral density (whole body)

change in bone mineral density in whole body, measured with DEXA (t-score and z-score)

Time frame: 12 months after the start of intervention

change in fecal calprotectin

Time frame: 3 months

change in tnf-alpha levels in colonic mucosa

change in mucosal tnf-alpha levels. Biopsies will be taken with the forceps from the colonic mucosa (colon sigmoid) and stored in RNA later media for the further analysis for TNF alpha concentration with PCR method.

Time frame: 3 months

change in tnf-alpha (in colonic mucosa)

Biopsies and analysis will be carried out as described ata 3 months follow-up

Time frame: 12 months after baseline