Could A Vitamin D Analog Significantly Reduce Fatigue?

Fatigue is a troubling symptom for many MS patients. It can affect every aspect of a person’s life. I myself have experienced fatigue, and I have worked with dozens of patients who have trouble holding jobs and maintaining relationships because of crushing fatigue. Stimulant medications can be useful in counteracting symptoms, but as of now there are no medications specifically approved for the treatment of MS related fatigue. However, a recent study may have found a way to manage fatigue with a vitamin D analog called alfacalcidol. Before I go over the study I just want to review a little bit more about vitamin D since it has been such a hot topic in the MS world.

Vitamin D is not only a vitamin but also a hormone that is made by your body. It plays a role in calcium absorption, maintaining bone health, and it also has also been shown to contribute to a number of conditions such as osteoporosis, depression, and multiple sclerosis. Specifically, a deficiency of vitamin D has been shown to play a role in MS but we aren’t sure exactly what that role is. One hypothesis is that MS inflammation causes a destruction of vitamin D, and another is that low levels of Vitamin D lead to the development of MS. What we do know is that low vitamin D levels lead to more disease activity such as new lesions and muscle weakness. This is why many patients with MS have their vitamin D levels checked, and often take supplements. Vitamin D deficiencies are not just common among people with multiple sclerosis, but have been shown to occur in up to 77% of adults. Your skin needs to absorb sunlight on a regular basis in oder for your body to produce vitamin D so deficiencies are especially common in certain parts of the world, during the winter, and in people who regularly wear sunscreen before going outdoors.

While many neurologists have been busy studying the role of vitamin D in MS, Dr. Anat Achiron and his team at the Sheba Medical Center in Israel has been studying the effect of a vitamin D analog called alfacalcidol on fatigue. The abstract of their randomized, placebo-controlled trial was presented at a meeting of the American Academy of Neurology, but official data has not yet been published in a peer-reviewed journal. So even though the results are considered to be preliminary until they are published, the data from the study is still very exciting!

Alfacacidol is a synthetic analog of vitamin D, which is a fancy way of saying we manufacture it in a lab like any other medication. The study included 158 patients ages 31-50, with EDSS scores ranging from 0-5.2. Of the patients enrolled, 92% had relapsing remitting multiple sclerosis. During the trial participants were given either alfacacidol or a placebo for 6 months and their fatigue level and quality of life was assessed at the beginning and at the end of the trial. On average the alfacacidol treated patients experienced a 41.6% reduction in fatigue after 6 months of treatment, and there were 8 relapses during the trial. The participants on the placebo medication reported a 27.% reduction in fatigue and there were 25 relapses.

Overall the result of the study was that the patients who received alfacacidol showed a dramatic decrease in fatigue levels, an increased quality of life, and had fewer relapses within the 6 month period. Another promising result of the study is that there were no side effects of alfacacidol treatment compared to the placebo. Based on this data Dr. Achiron’s and his team concluded that alfacacidol is both a safe and effective treatment of MS related fatigue. In an interview with MedPage Today Dr. Achiron noted that it is unclear whether over-the- counter vitamin D supplements would have the same benefits as alfacacidol, and trials with standard vitamin D are going on now.

Fatigue is one of the most common MS symptoms and to have a medication that could effectively reduced the burden of fatigue, while also being safe would certainly be great. I am looking forward to seeing more data, and to future studies. You can read the abstract of the study here.

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