Vitamin D for Sickle Cell (SCD Vitamin D)
Recruitment status was: Active, not recruiting
Vitamin D deficiency (VDD) is very common among African American adolescents and adults in the US, ten times higher than is seen in Caucasians. VDD is also quite common in sickle cell disease (SCD). Both VDD and SCD can cause chronic pain, compression fractures, and muscle weakness. The investigators believe VDD may contribute to poor musculoskeletal health and chronic pain seen in pediatric SCD. In this study, the investigators aim to show that children and adolescents with SCD and chronic pain have lower levels of vitamin D compared to those without chronic pain. The investigators also aim to determine the clinical characteristics in SCD patients related to their vitamin D status.
About 60 subjects (7 to 21 years old) will be enrolled on this study, 30 with chronic pain and 30 without chronic pain. The investigators will assess baseline characteristics including vitamin D levels, bone turnover rates (measured by C telopeptide blood levels [CTx]), markers of inflammation and oxidative stress levels in blood, baseline hemoglobin and other laboratory parameters, presence of abnormal bones on chest x-ray, pulmonary function, opioid analgesic use, overall muscle strength, quality of life and depression.
To evaluate the impact of vitamin D replacement on these baseline characteristics, the investigators will randomize subjects to receive either placebo or high dose vitamin D for 6 weeks after which time the investigators will evaluate overall vitamin D status, muscle and bone health, depression, quality of life, pain status and use of opioid pain medications, inflammation and oxidative status comparing before and after treatment with high dose vitamin D. The investigators will give—at no cost to subjects—a daily supplement that will provide the recommended daily allowance of calcium and vitamin D that contains 500mg Calcium and 200IU vitamin D to subjects throughout the study period. Subjects will be in the study for 7 months and have five to six study visits.
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Subject)
Primary Purpose: Prevention
|Official Title:||Pilot Study of Vitamin D to Ameliorate Chronic Pain in Sickle Cell Disease|
- Rate and extent of vitamin D deficiency [ Time Frame: 6 months after last patient exits study ]To determine the rate and extent of VDD in SCD patients with and without chronic pain
- clinical outcomes associated with vitamin D deficiency [ Time Frame: 1 year after last patient exits study ]To evaluate the musculoskeletal health, pain status, opioid analgesic use, depression and quality of life in SCD patients with and without chronic pain and determine if the presence or severity of VDD is associated with a more severe clinical phenotype
- Vitamin D deficiency correction [ Time Frame: 6 months after last patient exits study ]To determine if administration of high dose vitamin D will correct VDD in patients with SCD and if this correction will improve musculoskeletal health and ameliorate chronic pain
- serum markers of inflammation and oxidant stress versus vitamin D status [ Time Frame: 1 year after last specimen collected ]To evaluate and describe any correlates between vitamin D status and serum levels of inflammatory cytokines and markers of oxidative stress in SCD patients with and without chronic pain
- Vitamin D receptor polymorphisms versus vitamin D and chronic pain status [ Time Frame: 1 year after last patient exits from study ]To evaluate and describe any correlates between vitamin D status and vitamin D receptor polymorphisms in SCD patients with and without chronic pain.
|Study Start Date:||February 2009|
|Estimated Study Completion Date:||December 2013|
|Primary Completion Date:||December 2011 (Final data collection date for primary outcome measure)|
Active Comparator: Vitamin D
10,000 IU per caplet, with vitamin D dose based on weight, ranging from 240,000 IU to 600,000 IU. Patients will receive calcium/vitamin D daily soft chew as well.
Drug: Vitamin D
10,000 IU/caplet, patients receiving 240,000 IU to 600,000 IU cumulative Vitamin D dose based on weight.
Other Name: cholecalciferol
Placebo Comparator: Placebo
placebo only, all patients will receive calcium/vitamin D chew
placebo with daily calcium/Vitamin D soft chews
Nearly 43% of African American adults and 53-70% of African American adolescents in the US have vitamin D deficiency (VDD), ten times more than is seen in Caucasians. VDD is also quite common in sickle cell disease (SCD) with prevalence rates of 65-100%. Pain is a hallmark symptoms of SCD accounting for the majority of SCD morbidity. Some patients with SCD develop debilitating chronic pain with an unclear etiology and unsatisfactory response to treatment. Both VDD and SCD can cause chronic pain, compression fractures and myopathy. We hypothesize that VDD is implicated in the poor musculoskeletal health and chronic pain of SCD. Therefore we aim  to demonstrate that pediatric sickle cell patients have high rates of VDD and those with chronic pain have lower levels of vitamin D compared to those without chronic pain  to evaluate the musculoskeletal health, pain status, opioid analgesic use, depression and quality of life in SCD patients with and without chronic pain and determine if the presence or severity of VDD is associated with a more severe clinical phenotype and  to demonstrate that administration of replacement doses of vitamin D will correct VDD, improve musculoskeletal health and ameliorate chronic pain. An additional aim of this project is to  evaluate and describe any correlates between vitamin D status and serum levels of inflammatory cytokines, markers of oxidative stress and vitamin D receptor polymorphisms in SCD patients with and without chronic pain.
We will evaluate 60 SCD subjects aged 7-21 years (30 with chronic pain and 30 without chronic pain) for VDD and to determine specific baseline characteristics including 25(OH)D levels, bone turnover rates measured by C telopeptide serum levels (CTx), opioid analgesic use, neuromuscular strength, evidence of skeletal complications on chest radiograph, depression and quality of life, serum levels of inflammatory cytokines and oxidative status and characteristics of the vitamin D receptor (VDR). These characteristics will be compared between those with chronic pain and those without chronic pain. We will have a 30 day run in observation period during which baseline pain status will be determined by daily pain diary report. All subjects with then be randomly assigned to receive vitamin D replacement therapy or placebo for six weeks and prospectively followed for six months. All subjects will be given daily recommended daily allowance (RDA) of calcium and vitamin D in the form of a soft chew containing 500 mg calcium and 200 IU vitamin D throughout the study period. The primary endpoints are changes in serum 25(OH)D and CTx levels and opioid analgesic use (mg/kg morphine equivalent). Secondary endpoints include changes in pain status as documented by diary, depression scores, quality of life scores, neuromuscular strength and changes in serum cytokine levels and markers of oxidative stress.
In this study we hypothesize that VDD either contributes to or exacerbates sickle cell chronic pain and that correcting VDD in SCD will result in decreased pain, depression and opioid analgesic use; an improvement in musculoskeletal health; as well as a reduction in degree of inflammation and oxidative stress. This is a pilot study in preparation for a larger prospective trial evaluating the role of VDD in the pathobiology of SCD pain and musculoskeletal health.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01331148
|United States, Georgia|
|Children's Healthcare of Atlanta|
|Atlanta, Georgia, United States, 30322|
|Principal Investigator:||Ifeyinwa Osunkwo, MD, MPH||Children's Healthcare of Atlanta|