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| 標題: | Comparative effectiveness of valproic acid in different serum concentrations for maintenance treatment of bipolar disorder: A retrospective cohort study using target trial emulation framework |
| 作者: | Chen, Yang-Chieh Brian
Liang, Chih-Sung
Wang, Liang-Jen
Hung, Kuo-Chuan
Carvalho, Andre F.
Solmi, Marco
Vieta, Eduard
Tseng, Ping-Tao
Lin, Pao -Yen
Tu, Yu-Kang
Hsu, Chih-Wei
Lai, Edward Chia-Cheng |
| 貢獻者: | Chang Gung Memorial Hospital
Chang Gung University
Tri-Service General Hospital
National Defense Medical Center
Chang Gung University
Chang Gung Memorial Hospital
Chi Mei Hospital
Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science
Deakin University
University of Ottawa
Ottawa Hospital Research Institute
University of Ottawa
Ottawa Hospital Research Institute
Free University of Berlin
Humboldt University of Berlin
Charite Universitatsmedizin Berlin
University of Barcelona
Hospital Clinic de Barcelona
IDIBAPS
CIBER - Centro de Investigacion Biomedica en Red
CIBERSAM
National Sun Yat Sen University
Asia University Taiwan
Chang Gung Memorial Hospital
National Taiwan University
National Taiwan University
National Taiwan University Hospital
National Cheng Kung University
National Cheng Kung University
Chang Gung Memorial Hospital |
| 關鍵字: | lithium levels
pharmacokinetics
divalproex
psychiatry
binding |
| 日期: | 2022 |
| 上傳時間: | 2023-12-11 13:58:45 (UTC+8) |
| 出版者: | ELSEVIER |
| 摘要: | Background There is a lack of consensus on the optimal serum valproic acid (VPA) concentration for maintenance therapy in bipolar disorder (BD). We aimed to investigate the association between serum VPA levels and risk of mood episode recurrence.Methods We enrolled patients with BD from multiple medical institutions in Taiwan between January 1, 2001 and December 31, 2019. Patients were divided into three groups according to their serum VPA concentrations (< 50 mu g/ ml, 50-74 mu g/ml, and 75-104 mu g/ml). Adjusted hazard ratios (aHR) with 95% confidence intervals (CIs) compared times to mood episode recurrence using the < 50 mu g/ml group as reference. A systematic review found relevant articles published before February 2022 (PROSPERO: CRD42022309661), and corresponding results were compared.Findings This cohort included 896 patients for an intention-to-treat analysis. Compared with the < 50 mu g/ml group, a non-significantly lower risk of mood episode recurrence was found in the 50-74 mu g/ml (aHR, 95% CI: 0.86, 0.71 -1.05) and 75-104 mu g/ml (0.91, 0.71-1.18) groups. A per-protocol analysis of 481 patients found a significant risk reduction in the 50-74 mu g/ml group (0.76, 0.60-0.97), with inconclusive results in the >= 75 mu g/ml group (1.03, 0.73-1.46). A meta-analysis including two studies (254 patients) and our cohort found a similar significantly lower risk of mood episode recurrence in the 50-74 mu g/ml group (HR, 95% CI: 0.83, 0.69-0.99), while risk reduction in the 75-99 mu g/ml group (0.62, 0.26-1.48) did not differ significantly from that in the < 50 mu g/ml group or the 50-74 mu g/ml group.Interpretation The combined results of this cohort and previous studies suggest that VPA between 50-74 mu g/ml may be a more effective concentration to prevent acute mood episodes during maintenance therapy in patients with BD compared with VPA < 50 mu g/ml.Funding Ministry of Science and Technology, Taiwan, and Chang Gung Medical Research Project.Copyright (c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) |
| 關聯: | ECLINICALMEDICINE, v.54, 101678 |
| 顯示於類別: | [醫務管理系(所)] 期刊論文
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