(231) Improving vitamin adherence for cystic fibrosis patients through video-observed therapy

Background: Cystic fibrosis (CF) patients require vitamin D (VD) supplementation due to malabsorption from pancreatic insufficiency [1]. VD is a key nutrient for bone health and other long-term outcomes [1], which continue to gain prominence in modern CF management due to prolonged patient lifespans. Patients may struggle with daily vitamin adherence, particularly when juggled with an already extensive CF treatment regime, thus VD deficiency is a common and correctable problem among CF patients.

The QEII Adult CF Program in Halifax, Canada, introduced a video-observed therapy (VOT) program for weekly, high-dose VD supplementation. This program aimed to identify patients who struggled with their supplementation, address their barriers through a patient-centered approach, increase their serum 25-hydroxyvitamin D levels (25-OHD), and build habits that are long-term and sustainable for their lifestyles.

Methods: All patients with a low 25-OHD were contacted (n=48), and program participation was voluntary. Patients were offered vitamin D₃ 20,000 international units (IU) weekly or 50,000IU weekly, based on their pre-program serum level and dosing. These doses were within stepwise dosing guidelines for VD [2], and in consultation with the local endocrinology team.

Participants chose their weekly communication method (text, video-chat, etc.) and preferred day/time for the 12-week regime. They received a reminder text at the pre-set time each week for their VOT dose. Follow-up bloodwork measured their 25-OHD after the program and patients were informed of their result. Afterward, they were given the choice of follow-up VD routine (i.e., daily vs. weekly dose, observed vs. unobserved, and with a reminder vs. self-directed). Follow-up bloodwork was scheduled 6 months thereafter to assess longer-term compliance to their self-selected regime.

Results: 21/26 patients (80.8%) completed the 12-week program (Figure 1). Patients in the 20,000IU/week arm (n=11) had a 75% mean increase in their baseline 25-OHD. Patients in the 50,000IU/week arm (n=10) had a 153% mean increase in their baseline 25-OHD. There were no cases of VD toxicity. 5 patients (23.8%) had post-program levels below the 25-OHD lower limit of normal (LLN), all of whom endorsed not taking their VD with a fatty meal and/or pancreatic enzymes. 20/21 patients (95.2%) opted to maintain a weekly, self-directed routine after completing the program.

Conclusions: The VOT program demonstrated a significant increase in serum 25-OHD among participants. For patients whose serum 25-OHD remained below the LLN, this program served as an effective educational tool for pairing their VD with a fatty meal and/or digestive enzymes. Patients were satisfied with tailoring the program to their personal preferences and regular touchpoints with the clinic team to strengthen their therapeutic relationship. Due to the program’s successes thus far, it has remained a standard option of intervention for low 25-OHD at the QEII Adult CF clinic. Along with VD, this program may also be tailored toward different aspects of CF management.

Acknowledgements:

References: [1] Juhász M, Varannai O, Németh D, Szakács Z, Kiss S, Izsák V et al. Vitamin D supplementation in patients with cystic fibrosis: A systematic review & meta-analysis. J Cyst Fibros. 2021;20(5):729-736. https://doi.org/10.1016/j.jcf.2020.12.008.

[2] Cystic Fibrosis Foundation. Vitamin D guidelines, https://www.cff.org/vitamin-d-deficiency-clinical-care-guidelines; 2019 [accessed 31 March 2022].