Endocrine Abstracts (2012) 28 P19

Efficacy of differing vitamin D supplementations, and the associated cost implications

James Gill, Subash Sivaraman, Hina Mistry, Mandeep Heer & Harpal Randeva

Endocrinology - WISDEM CENTRE, University Hospital Coventry and Warwickshire, Coventry, United Kingdom.

The aim of this audit was to assess the efficacy of vitamin D replacement therapies (oral Ergocalciferol D2 and Cholecalciferol D3) on serum Vitamin D (25(OH)D), when dispensed to endocrine outpatients. After exclusions, clinic records of 54 patients were analysed for pre- and post dosage serum 25(OH)D levels, PTH levels, total dosage given, and duration of replacement. Results: Mean total dose of D2 (n=24) was 350,000 (IU) against D3 (n=30) 305,000 (IU), with average duration of 79.7 and 91 days respectively. Mean change in serum 25(OH)D for D2 was 40.42 (SD 22.10) (nmol/l) whilst for D3, 59.7 (SD 39.27)(nmol/l) (P 0.017). Student’s T-test showed that, in the clinic setting within a tertiary UK centre, Cholecalciferol has a significantly more effect than Ergocalciferol on subsequent vitamin D levels Presently, equal if not more scrutiny is now directed towards fiscal efficiency as it is towards treatment effectiveness. There is good evidence for aggressive replacement therapy particularly when viewed as a means to prevent future causes of morbidity, especially through reducing fractures of the hip. In the recent past, availability of particular vitamin D supplements have varied, with new prescriptions of D2 or D3 written based on availability as much as clinical indication. Previous RCTs have suggested that Cholecalciferol supplementation (which is up to 90% cheaper) delivers serum 25(OH)D improvements, up to 33% greater than those achievable using Ergocalciferol. In the current financial climate, with such significant price variances and mounting evidence of a superior outcome from D3 replacement, we therefore suggest that Cholecalciferol should be the preferred drug for severe vitamin D deficiency.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.

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