The role of vitamin D in the prevention and treatment of tuberculosis: a meta-analysis of randomized controlled trials.

Abstract

Purpose: To explore the role of supplementing vitamin D in the prevention and treatment of tuberculosis infection through a meta-analysis of randomized controlled trials.

Methods: The databases of PubMed, Cochrane Library, Embase, and Web of Science were systematically searched from inception to April 21, 2024, to identify studies comparing vitamin D supplementation with non-vitamin D supplementation for tuberculosis infection prevention or treatment. The inclusion criteria were randomized controlled trials involving participants diagnosed with either no tuberculosis or tuberculosis, with the intervention group receiving vitamin D supplementation and the control group receiving a placebo or standard treatment, and reporting outcomes related to tuberculosis prevention or treatment effects. The exclusion criteria were studies without full text and those not meeting the specific participant or treatment criteria. The analysis was performed using the Inverse Variance method with a random-effects model. Subgroup analyses were conducted to explore the impact of different administration routes. The stability of the pooled results was assessed using the leave-one-out method. Publication bias was evaluated with Egger's and Begg's tests.

Results: We identified a total of 26 eligible trials, involving 19,586 participants. Four trials compared the preventive effects of vitamin D supplementation on tuberculosis infection, and the results (RR 0·75; 95% CI 0·56 to 1·01) were inconclusive. Regarding the role of vitamin D supplementation in anti-tuberculosis treatment, there were no significant statistical differences between the vitamin D and non-vitamin D groups in sputum smear conversion, sputum culture conversion, or time to sputum culture conversion. However, patients in the vitamin D group showed significantly lower Tuberculosis scores at 8 weeks (MD - 0·39; 95% CI -0·57 to -0 22) and 12 weeks (MD - 0·53; 95% CI - 0·84 to - 0·22). There were similar safety profiles between the two groups. Subgroup analysis based on the frequency of vitamin D intake revealed that patients who received daily vitamin D supplementation had higher rates of sputum smear conversion at 6 weeks and 8 weeks. They also had lower TB scores at 8 weeks.

Conclusion: Supplementing with vitamin D during anti-tuberculosis treatment does not accelerate the clearance of tuberculosis bacteria, but it can improve patient symptoms.