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Given the inconsistent findings on the vitamin D supplementation in MS, we aimed to analyse the connection between 25(OH)D levels and disease activity and to identify an optimal level of 25(OH)D in MS utilizing our real-world database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study utilized a 10-year dataset from the Czech national multiple sclerosis registry (ReMuS), encompassing 1,861 adult MS patients. Patients had a minimum of one year of follow-up, with subgroup analysis for those with at least five years. A mixed-effects model tested the impact of 25(OH)D and cholesterol levels on relapse incidence. Subgroup analysis categorised patients by average 25(OH)D levels and analysed relapse incidence using the Kruskal-Wallis test and Kaplan-Meier survival analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Higher serum 25(OH)D levels and age correlated with reduced relapse risk (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 for both). Each 10 nmol\/L increase in 25(OH)D levels associated with a 6.7% decrease in relapse risk (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Cholesterol levels and sex did not significantly affect relapse rate. Subgroup analysis revealed that patients with 25(OH)D levels above 100 nmol\/L had significantly fewer relapses compared to those with levels below 75 nmol\/L.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings suggest that optimising 25(OH)D levels may reduce the risk of relapse in pwMS. Causation cannot be confirmed. Results highlight the importance of personalized vitamin D supplementation strategies and support the potential benefit of maintaining optimal serum 25(OH)D levels in MS management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10072-025-08729-z","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T14:05:33Z","timestamp":1766498733000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["From sunlight to MS fight: impact of vitamin D levels on multiple sclerosis activity"],"prefix":"10.1007","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8158-724X","authenticated-orcid":false,"given":"Marta","family":"Vachova","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2418-4847","authenticated-orcid":false,"given":"Dominika","family":"Stastna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0398-9419","authenticated-orcid":false,"given":"Aneta","family":"Mazouchova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavla","family":"Hruskova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3160-9022","authenticated-orcid":false,"given":"Tomas","family":"Uher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0337-3462","authenticated-orcid":false,"given":"Jana","family":"Preiningerova Lizrova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8241-7798","authenticated-orcid":false,"given":"Pavel","family":"Potuznik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3416-2094","authenticated-orcid":false,"given":"Jiri","family":"Drahota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9543-4359","authenticated-orcid":false,"given":"Eva","family":"Kubala Havrdova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"8729_CR1","doi-asserted-by":"publisher","first-page":"1816","DOI":"10.1177\/1352458520970841","volume":"26","author":"C Walton","year":"2020","unstructured":"Walton C, King R, Rechtman L (2020) Rising prevalence of multiple sclerosis worldwide: insights from the Atlas of MS, third edition. 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Vachova received\u00a0compensation for travel and\/or conference fees and\/or consulting fees and\/or speaker honoraria from Biogen, Merck, Novartis, Roche, Sanofi, and Teva; D. Stastna received\u00a0financial support for conference travel and\/or speaker honoraria and\/or consulting fees from Novartis, Biogen, Merck, Bayer, Janssen-Cilag, and Pfizer; P. Potuznik received\u00a0compensation for travel and\/or speaker honoraria and\/or consultant fees from Biogen, Novartis, Merck, Roche, and Sanofi. J. Drahota received speaker honoraria from Novartis and\u00a0Roche; E. Kubala Havrdova received speaker honoraria, compensation for travel, and consultant fees from Biogen, Merck, Novartis, Sanofi, and Teva, as well as support for\u00a0research activities from Biogen and Merck; none of the other authors has any conflict of interest to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"38"}}