D Vitamini Tedavisinin Yan Etkileri ve D Vitamini Tedavisi Sürecinde Dikkat Edilecek Hususlar
Özet
D vitamini, bağışıklık sistemini düzenleyici rolüyle COVID-19 ve diğer viral solunum yolu enfeksiyonlarına karşı potansiyel destek sağlayan önemli bir steroid hormondur. COVID-19 patogenezinde virüs, ACE-2 reseptörlerine bağlanarak hücreye girer ve bazı ağır vakalarda "sitokin fırtınası" olarak adlandırılan hiperinflamatuar bir yanıta yol açarak hayati risk oluşturur. D vitamini ise proinflamatuar sitokinleri (IL-1, IL-6, TNF-alfa) azaltıp antiinflamatuar IL-10 düzeyini artırarak bu aşırı bağışıklık yanıtını baskılayabilir ve doku hasarını önleyebilir. Yapılan ekolojik ve retrospektif çalışmalar, serum 25(OH)D düzeyi düşük (<20 ng/ml) olan COVID-19 hastalarında klinik seyrin daha kötü, ölüm oranlarının daha yüksek olduğunu; yeterli düzeydeki (>30 ng/ml) bireylerde ise hipoksi riski ve mortalitenin azaldığını göstermektedir. Enfeksiyondan korunma veya hastalık şiddetini hafifletmek için serum konsantrasyonunun 40-50 ng/ml üzerine çıkarılması ve günlük 1000-2000 IU vitamin D3 takviyesi önerilmektedir. Koruyucu etki günlük veya haftalık düzenli kullanımlarda görülürken, yüksek doz bolus rejimlerinde aynı başarı elde edilememiştir. Aşırı yüksek dozlar (günlük 10.000-40.000 IU) hiperkalsemi ve doku kalsifikasyonu gibi toksisite riskleri taşımaktadır. D vitamini tek başına bir mucize olmasa da, virüs replikasyonunu kontrol etme ve hiperinflamasyonu azaltma potansiyeliyle destek tedavide klinik araştırmalara değer bir ajan olarak öne çıkmaktadır.
Vitamin D is a crucial steroid hormone that acts as an immunomodulator, offering potential support against COVID-19 and other viral respiratory infections. In COVID-19 pathogenesis, the virus enters cells via ACE-2 receptors, which can lead to a life-threatening "cytokine storm" through a hyperinflammatory response in severe cases. Vitamin D can suppress this excessive immune response and prevent tissue damage by decreasing pro-inflammatory cytokines (such as IL-1, IL-6, TNF-alpha) while increasing anti-inflammatory IL-10 levels. Ecotoxicological and retrospective studies demonstrate that COVID-19 patients with low serum 25(OH)D levels (<20 ng/ml) experience poorer clinical outcomes and higher mortality rates, whereas individuals with sufficient levels (>30 ng/ml) show reduced risks of hypoxia and death. To prevent infection or mitigate disease severity, elevating serum concentrations above 40-50 ng/ml and maintaining a daily supplementation of 1000-2000 IU of vitamin D3 is recommended. While the protective effect is observed with regular daily or weekly intake, high-dose bolus regimens have not yielded the same success. Excessive doses (10,000-40,000 IU daily) carry toxicity risks, including hypercalcemia and tissue calcification. Although vitamin D is not a standalone miracle cure, its potential to control viral replication and reduce hyperinflammation makes it a noteworthy agent in supportive treatment that warrants further clinical research.
Referanslar
Taylor PN, Davies JS. A review of the growing risk of vitamin D toxicity from inappropriate practice. Br J Clin Pharmacol. 2018;84(6):1121-7.
Pereira-Santos M, Costa PR, Assis AM, et al. Obesity and vitamin D deficiency: a systematic review and meta- analysis. Obes Rev 2015;16:341–9.
Hochberg Z, Bereket A, Davenport M, et al; European Society for Paediatric Endocrinology (ESPE) Bone Club. Consensus development for the supplementation of vitamin D in childhood and adolescence. Horm Res. 2002;58(1):39-51.
Alshahrani F, Aljohani N. Vitamin D: deficiency, sufficiency and toxicity. Forum Nutr 2013;5:3605–16.
Kesiktaş FN, Kulle TY. Vitamin D ve Kalsiyum Takviyesi. Klinik Tıp Aile Hekimliği Dergisi 2019;11:90-5.
Moyer VA, U.S. Preventive Services Task Force. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;158(9):691-6.
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al; EndocrineSociety. Evaluation, treatment and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96(7):1911-30.
Buluş D, İnan Y, Demet E, Andıran N. D vitamini intoksikasyonuna bağlı hiperkalsemi: Olgu sunumu. Türkiye Çocuk Hast Derg. 2016;10(4):277-9.
Bülent K, Şükrü H. Depo D vitamini tedavisi ne kadar masum? Sürekli Tıp Eğitimi Dergisi (STED) 2001;10:460-1.
Hu H, Zhang J, Lu Y, et al. Association between circulating vitamin D level and urolithiasis: A systematic review and meta-analysis. Nutrients 2017;18:9(3):301.
Wat H, Dytoc M. Off-label uses of topical vitamin D in dermatology: a systematic review. J Cutan Med Surg. 2014;18(2):91-108.
Berth-Jones J, Hutchinson PE. Vitamin D analogues and psoriasis. Br J Dermatol 1992;127:71–8,
Bleiker TO, Bourke JF, Mumford R, Hutchinson PE. Long-term outcome of severe chronic plaque psoriasis following treatment with high-dose topical calcipotriol. Br J Dermatol 1998;139:285–6.
Uliasz A, Lebwohl M. Erdem T. Diğer topikal tedaviler. In: Bolognia JL, Jorizzo JL, Rapini RP (eds), Sarıcaoğlu H, Başkan EB (çeviri editörleri). Dermatoloji. Türkçe 1. Baskı.(cilt 1) İstanbul, Nobel Tıp Kitabevleri, 2012;1991-2003.
Basak PY, Ergin S. Comparative effects of calcipotriol and betamethasone 17-valerate solution in the treatment of seborrhoeic dermatitis of the scalp. J Eur Acad Dermatol Venereol 2001;15:86–8.
Van de Kerkhof PC, Steijlen PM. Topical treatment of pityriasis rubra pilaris with calcipotriol. Br J Dermatol 1994;130:675–8.
Carboni I, de Felice C, Bergamin A, Chimenti S. Topical use 3. of calcitriol 3 microg/g ointment in the treatment of mild-to-moderate psoriasis: Results from an open-label study. J Eur Acad Dermatol Venereol 2005;19:(suppl 3)11–3.
Ortonne JP, Humbert P, Nicolas JF, et al. Intra-individual comparison of the cutaneous safety and efficacy of calcitriol 3 microg g(-1) ointment and calcipotriol 50 microg g(-1) ointment on chronic plaque psoriasis localized in facial, hairline, retroauricular or flexural areas. Br J Dermatol 2003;148:326–33.
Lebwohl M, Menter A, Weiss J, et al. Calcitriol 3 microg/g ointment in the management of mild to moderate plaque type psoriasis: Results from 2 placebo-controlled, multicenter, randomized double-blind, clinical studies. J Drugs Dermatol. 2007;6:428–35.
Rizova E, Corroller M. Topical calcitriol--studies on local tolerance and systemic safety. Br J Dermatol. 2001;144 Suppl 58:3-10.
Kaidbey KH, Kligman AM. Photomaximization test for identifying photoallergic contact sensitizers. Contact Dermatitis. 1980 Apr;6(3):161-9.
Segaert S, Duvold LB. Calcipotriol cream: a review of its use in the management of psoriasis. J Dermatolog Treat. 2006;17(6):327-37.
Stadler R, Bohmeyer J. Regarding the effectiveness and tolerability of a cream containing calcipotriol (PsorcutanH) in the treatment of psoriasis vulgaris. Z Hautkr. 1998;73:593–6.
Trémezaygues L, Reichrath J. Vitamin D analogs in the treatment of psoriasis: Where are we standing and where will we be going? Dermatoendocrinol. 2011;3(3):180-6.
Barker JN, Ashton RE, Marks R, et al. Topical maxacalcitol for the treatment of psoriasis vulgaris: a placebo-controlled, double-blind, dose-finding study with active comparator. Br J Dermatol 1999; 141: 274–8.
Dua I, Aggarwal K, Jain VK. Comparative evaluation of efficacy and safety of calcipotriol versus tacalcitol ointment, both in combination with NBUVB phototherapy in the treatment of stable plaque psoriasis. Photodermatol Photoimmunol Photomed. 2017 Sep;33(5):275-81.
Van de Kerkhof PC, Berth-Jones J, Griffiths CE, et al. Long-term efficacy and safety of tacalcitol ointment in patients with chronic plaque psoriasis. Br J Dermatol 2002; 146: 414–22.
