Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients With Moderate to Severe COVID-19: A Randomized Clinical Trial

SPS commentary:

An editorial notes that although this is an important contribution as the largest published randomized, double-blind, placebo-controlled trial of vitamin D3 administration among hospitalized patients with COVID-19 to date, several limitations should be considered. First, the study was underpowered, second, the authors excluded patients who required invasive mechanical ventilation and those admitted to the ICU, and <15% of patients required noninvasive ventilation, thus most of the patient population would be considered moderately ill and the results cannot be generalised to critically ill patients, who were excluded. Third, only 115 study participants (48.3%) had vitamin D deficiency and only about one-fourth of had severe vitamin D deficiency so it is unclear whether patients were able to efficiently convert 25(OH)D to 1,25-dihydroxyvitamin D, because this conversion is inhibited by the osteocyte-derived hormone fibroblast growth factor 23, which is elevated in acutely ill patients. However, it concludes that taken together with existing RCTs of vitamin D administration in hospitalised patients with respiratory infection and critical illness, these current results do not support routine administration of vitamin D in hospitalised patients with moderate to severe COVID-19.