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For those of you too young to appreciate my reference, Let the sunshine in, was the second of two songs in a medley for the musical, Hair, made popular by the 5th dimension in 1969. Heading west to find oneself as well as sunshine was all the craze at the time, but I am apparently a slow learner since it took me over 40 years to move out west. But I digress; I intended to talk about Vitamin D, the sunshine vitamin, and MS. If you bear with me, I will even provide the name of the first song in the hair medley that accompanied, Let the sunshine in.
First the facts:
Why should you take Vitamin D for your MS? For many years epidemiologists have appreciated a latitude gradient with MS incidence; namely, the further north you go from the equater in the northern hemisphere or the further south in the southern hemisphere, the incidence of MS rises. Most evidence suggests that this latitude effect is due to decreasing exposure further from the equator to the ultraviolet B light required to make vitamin D in the skin. More recently we’ve learned that vitamin D is involved in the regulation of the innate and adaptive immune system as well as it’s typical role in calcium and bone metabolism. The evidence in support of a role for vitamin D deficiency in MS is mounting rapidly and includes the following information:
To answer many of these questions, several controlled clinical trials are underway in the United States and Europe to determine if high dose vitamin D Supplementation is beneficial in MS. If you are interested in learning about these studies, please go to clinicaltrials.gov and search for studies of vitamin D in Multiple Sclerosis. Since all studies suggest that doses under 10,000 IU a day are safe, it is most prudent to begin supplementation now unless there is a contraindication to treatment. Please check with your doctor first to determine if vitamin D supplements are safe in your situation. Now back to the trivia question that started this blog; the first song in the Hair medley was called, The age of Aquarius. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego
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Here is My Question:
I had been diagnosed with MS in 2011, and since then I had been on Avonex with minimal side effects (like fever lasting for approximately 12-18 hours). Then I switched to Plegridy in November 2019. I thought the prolonged duration of fever (3-4 days) would subside after the initial few months, but it has not. My questions are: 1. Is it okay to switch back to Avonex? 2. Is Avonex equally effective as Plegridy? P. S. I have had no relapse episode since 2011, and no visual symptoms apart from fatigue, though MRI had a one new lesion of activity three years back. Answer: Your question reflects the normal parsing of responsibilities in any doctor-patient relationship; you, the patient, are the only one who can decide what type of treatment is acceptable and whether any side effects you experience are manageable; we, the physicians, provide information and guidance on the relative efficacy and risks of these treatments. As a corollary, we also advise people on how to maximize the efficacy and minimize the risks. In your case I will hazard the guess that you've already decided you want to stop Plegridy and restart Avonex; this, in fact, is a good decision given the enhanced side effects you've experienced with Plegridy. To help you with this decision, without actually making the decision, let me tell you that both Plegridy and Avonex are the same active substance, Interferon Beta-1a. There is no evidence that Plegridy offers enhanced benefits other than the convenience of less frequent injections. Neutralizing antibody formation seems to lower with Plegridy but you did not have any problems with Avonex previously and I doubt this would be an issue now. So, feel confident and make the decision you want to make, and free yourself from 3 days of side effects. Revere P (Rip) Kinkel, MD Professor of Clinical Neurosciences Director of the Multiple Sclerosis Program Clinical Neurosciences Director University of California San Diego |
PLEASE NOTE: This information/opinions on this site should be used as an information source only. This information does not create any patient-HCP relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.
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