Earlier this month the open access scientific journal Biomedicines published a observational study on the effect of the calcitriol supplementation in relation to the risk of SARS-CoV2 infection or COVID-19 mortality. This population study was based on a sample of 8076 patients resident in Catalonia who had been under treatment from April 2019 to February 2020.
Dr. participated in the study. Joaquim Oristrell and the pre-doctoral researcher Enrique Casado, from the research group on joint inflammatory disease, bone metabolism and systemic autoimmune diseases of the Parc Taulí Research and Innovation Institute (I3PT), together with Joan Carles Oliva, also from the I3PT.
Then we talk to Dr. Oristrell, principal investigator of the study, who will tell us where it originated, what it consisted of, what results they have obtained and what they represent in terms of progress in the fight against COVID-19.
What is calcitriol and under what premise was it decided to analyze the association between this treatment and SARS-CoV2 infection?
Calcitriol is the hormonally active form of vitamin D. We hypothesized that its supplementation might be beneficial in patients with COVID-19 for several reasons. On the one hand, there are two meta-analyzes that have shown that vitamin D supplementation can reduce the incidence of respiratory infections.
What we found most appealing is that calcitriol has beneficial effects in animal models of adult respiratory distress, which is the type of lung injury seen in COVID-19.
What are the main reasons for calcitriol supplementation in our population?
We analyzed the entire population of Catalonia that had purchased in pharmacies any of the preparations containing vitamin D, including calcitriol, in the year before the start of the pandemic.
We detected more than 8000 patients treated with calcitriol, basically patients with renal failure (approximately two-thirds of the total) or patients with hypoparathyroidism (one-fifth of the total). Approximately 1000 patients did not know what the indication was for supplementation.
What variables did they identify and what were the results obtained?
Outcome variables were SARS-CoV2 infection, hospitalization for COVID-19, severe infection (combined variable of noninvasive ventilation requirement or ICU admission or death), or death from COVID-19. . Demographic variables, living in residence, various comorbidities, or taking certain groups of drugs were analyzed as covariates.
The main result was that, compared with a control group paired by propensity score, with the same clinical features as those treated, COVID-19 mortality was 34% lower in supplemented patients. However, if we analyzed only patients with advanced renal failure, this percentage decrease in death was 43% in the multivariate analysis, while in patients without renal failure the differences were not significant.
Assessing these positive results, what conclusions can we reach and what application would they have at the current time of the pandemic?
In our study we were unable to show that calcitriol supplementation prevents SARS-CoV2 infection, but it does suggest that the infection becomes less severe, with less mortality. In no case can this supplementation replace vaccination, which has clearly been shown to be much more effective in reducing COVID-19 infection and mortality. However, since mutants of the virus may be produced in the future that may limit the effectiveness of vaccines, we believe that calcitriol supplementation may be especially useful in patients with advanced renal failure. However, it must be said that ours is an observational study, in which we cannot rule out the existence of any bias. Optimally, a clinical trial should be developed to be able to safely determine the effectiveness of this drug in COVID-19.
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