Elevated 1, 25-dihydroxyvitamin D levels are associated with protracted treatment in sarcoidosis

Respir Med. 2010 Apr;104(4):564-70. doi: 10.1016/j.rmed.2009.12.004. Epub 2010 Jan 13.


Background: Active vitamin D metabolite, 1, 25-dihydroxyvitamin D, has pleomorphic effects on both innate and acquired immunity. Sarcoid granuloma derived 1, 25-dihydroxyvitamin D leads to hypercalcemia, but the association of 1, 25-dihydroxyvitamin D with the clinical phenotype of the disease is currently unknown.

Objective: To determine the relationship between serum 1, 25-dihydroxyvitamin D levels and the degree of sarcoidosis disease chronicity.

Design: Serum 1, 25-dihydroxyvitamin D levels were measured and associated with sarcoidosis activity and phenotypes as assessed by Sarcoidosis Severity Score and Sarcoidosis Clinical Activity Classification respectively.

Results: Fifty nine patients were recruited with 44% having a sub-acute onset, and the chronic disease phenotype. There was no significant difference in serum 1, 25-dihydroxyvitamin D levels by chest radiograph stage (p = 0.092) nor did the levels correlate with the Sarcoidosis Severity Score (r = -0.16; p = 0.216). Serum 1, 25-dihydroxyvitamin D levels were associated with patients requiring repeated regimens of systemic immunosuppressive therapy or >1 year of therapy (SCAC Class 6). Increasing quartiles of serum 1, 25-dihydroxyvitamin D level was associated increased odds of the chronic phenotype (OR 1.82, 95% CI, 1.11, 2.99, p = 0.019). The majority (71%) of the patients with levels >51 pg/mL required chronic immunosuppressive therapy as defined by SCAC class 6.

Conclusions: In patients with sarcoidosis, elevated 1, 25-dihydroxyvitamin D levels are associated with chronic treatment needs.

MeSH terms

  • African Americans
  • Biomarkers / blood
  • Chronic Disease
  • Cross-Sectional Studies
  • Dihydroxycholecalciferols / blood*
  • European Continental Ancestry Group
  • Female
  • Humans
  • Hypercalcemia / etiology
  • Male
  • Middle Aged
  • Phenotype
  • Radiography
  • Sarcoidosis / blood*
  • Sarcoidosis / diagnostic imaging
  • Severity of Illness Index


  • Biomarkers
  • Dihydroxycholecalciferols