Department of Pharmacology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
Eur J Clin Pharmacol. 2024 Nov;80(11):1751-1759. doi: 10.1007/s00228-024-03741-2. Epub 2024 Aug 16.
Monitoring free valproate concentrations, as with other highly protein-bound anticonvulsants, is essential in clinical situations where protein binding may be disrupted. Conversion of measured total concentrations to approximate free concentrations offers a cost-effective alternative. This study evaluated the relationship between total and free valproate concentrations for discordance and the impact of key determinants. A novel formula was devised that incorporates significant variables.
A multicentre, cross-sectional observational analytical study included 101 subjects 18 years and older using valproate for 6 months or longer. Participants were recruited from private and public sector healthcare settings from primary to tertiary level in, South Africa, during 2017-2019.
Free valproate concentrations could be measured for 84 subjects. Discordance for concomitant total and free valproate concentrations was 79.1%. Among 19 participants with elevated free concentrations, 15 (78.9%) had total valproate concentrations within the recommended reference range. Calculations based on the study-derived formula were more accurate in predicting free valproate concentration than previously proposed methods.
This study proposes that the novel formula for calculating free valproate enables more accurate prediction.
在可能破坏蛋白结合的临床情况下，监测游离丙戊酸盐浓度（与其他高度蛋白结合的抗惊厥药一样）至关重要。将测量的总浓度转换为近似游离浓度提供了一种具有成本效益的替代方法。本研究评估了游离和总丙戊酸盐浓度之间的不匹配关系及其关键决定因素的影响。设计了一种新的公式，其中包含重要变量。
这是一项多中心、横断面观察性分析研究，纳入了 2017-2019 年期间在南非从初级到三级医疗机构使用丙戊酸盐治疗 6 个月或更长时间的 101 名 18 岁及以上的患者。
可测量 84 名患者的游离丙戊酸盐浓度。同时存在的总浓度和游离丙戊酸盐浓度的不匹配率为 79.1%。在 19 名游离浓度升高的参与者中，15 名（78.9%）的总丙戊酸盐浓度在推荐的参考范围内。与之前提出的方法相比，基于该研究的公式计算得出的游离丙戊酸盐浓度的预测更准确。
本研究表明，计算游离丙戊酸盐的新公式能够更准确地预测游离丙戊酸盐浓度。
