丙戊酸可能有助于对抗 COVID-19：一项病例对照研究。

Valproic acid could help in the fight against COVID-19: A case-control study.

机构信息

Endocrinology and Nutrition department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain.

Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.

出版信息

Neurologia (Engl Ed). 2024 Sep;39(7):549-554. doi: 10.1016/j.nrleng.2023.12.009.

DOI:10.1016/j.nrleng.2023.12.009

PMID:39232592

Abstract

OBJECTIVE

There is early evidence about Valproic acid (VPA) antiviral effect. Our aim was to investigate the incidence and severity of SARS-CoV-2 infection in VPA users as compared with the general population.

MATERIAL AND METHODS

A case-control study nested within a cohort, carried out between March 1 and December 17, 2020. Retrospectively, we identified confirmed SARS-CoV-2 infection patients exposed to VPA in our health department (defined as case). We ascertained VPA regimen (all the time (AT) (292 days) or at least 20% of the study period (notAT) (≥58 days) and if VPA levels were in therapeutic range (ATR) (50-100mcg/mL) in the last 24 months. We calculated the cumulative incidence of SARS-CoV-2 infection and hospital admission in the cases, comparing it with the general unexposed VPA population (controls).

RESULTS

During the study period, 6183 PCR+ were detected among 281,035 inhabitants, of these, 746 were hospitalized. 691 patients were on VPA notAT and 628 (90.1%) AT. The indication for VPA use was epilepsy in 54.9%. The incidence of PCR+ was 1.736% (OR 0.785 (95%CI 0.443-1.390) and 1.910% (OR 0.865 (95%CI 0.488-1.533), on VPA notAT and VPA AT patients, respectively vs. 2.201% in people without VPA regimen. Those patients with VPA ATR had a lower risk of PCR + (OR 0.233 (95%CI 0.057-0.951) notAT; OR 0.218 (95%CI 0.053-0.890) AT). Hospital admission incidence was lower in patient on VPA (OR was 0.543 (95% CI 0.076-3.871).

CONCLUSION

Patients with VPA within the therapeutic range had a reduction of SARS-Cov-2 infection incidence greater than 75%. There is a downward trend in the risk of COVID-19 admission by SARS-CoV-2 in patients on VPA therapy. These findings warrant further investigation.

摘要

目的

有早期证据表明丙戊酸（VPA）具有抗病毒作用。我们的目的是调查 VPA 使用者与普通人群相比 SARS-CoV-2 感染的发生率和严重程度。

材料和方法

这是一项病例对照研究，嵌套在队列研究中，于 2020 年 3 月 1 日至 12 月 17 日进行。回顾性地，我们确定了在我们的卫生部门暴露于 VPA 的确诊 SARS-CoV-2 感染患者（定义为病例）。我们确定了 VPA 方案（所有时间（AT）（292 天）或至少研究期间的 20%（非 AT）（≥58 天）和过去 24 个月中 VPA 水平是否在治疗范围内（ATR）（50-100mcg/mL）。我们计算了病例中 SARS-CoV-2 感染和住院的累积发生率，并将其与普通未暴露于 VPA 的人群（对照组）进行比较。

结果

在研究期间，在 281035 名居民中检测到 6183 例 PCR+，其中 746 例住院。691 名患者接受 VPA 非 AT 治疗，628 名（90.1%）接受 AT 治疗。VPA 治疗的适应症是癫痫，占 54.9%。PCR+的发生率分别为 1.736%（OR 0.785（95%CI 0.443-1.390）和 1.910%（OR 0.865（95%CI 0.488-1.533）），在 VPA 非 AT 和 VPA AT 患者中，而在无 VPA 方案的人群中为 2.201%。ATR 患者的 VPA 患者发生 PCR+的风险较低（OR 0.233（95%CI 0.057-0.951）非 AT；OR 0.218（95%CI 0.053-0.890）AT）。接受 VPA 治疗的患者住院的发生率较低（OR 为 0.543（95%CI 0.076-3.871）。