Comparison of Serum Total Valproic Acid Levels and %CDT Values in Chronic Alcohol Addictive Patients in an Italian Clinic: A Retrospective Study

Abstract

BackgroundValproate is a broad-spectrum anticonvulsant that is effective in the treatment of tonic-clonic, myoclonic and absence seizures as well as in partial seizures as a second-line drug. It has been widely demonstrated in the literature that the effect of valproate on type-A γ-aminobutyric acid (GABA-A) receptors may reduce relapse to ethanol abuse. This retrospective study evaluated a 3-year period in which 42 patients from the Department of Alcoholism and Substance Abuse (DASA) were treated with valproate.ObjectivesWe compared different serum total valproic acid (VPA) concentrations, and the effectiveness of this drug in maintaining alcohol abstinence was evaluated by percentage of carbohydrate deficient transferrin (%CDT) values.MethodCDT is a biochemical marker used for identifying regular high alcohol consumption and monitoring abstinence in outpatients during treatment. Serum concentrations of valproate were divided into four groups: <10, 10–30, 31–50, and >50 µg/mL.ResultsThis study shows that a mean serum total VPA concentration >30 µg/mL is more effective in maintaining alcohol abstinence than a lower one (p < 0.05). In this study, mean serum total VPA concentrations between 31 and 50 µg/mL showed the same effectiveness as higher ones (>50 µg/mL); in fact, there was no significant difference in mean %CDT values between these two groups (p > 0.05). After at least 12 months’ treatment with valproate, mean platelet counts increased by 12 × 103/μL compared with baseline (254 ± 63 vs 242 × 103/μL, p > 0.05, respectively) in patients with mean serum total VPA levels <10 μg/mL; increased by 8 × 103/μL from baseline (253 ± 59 vs 245 × 103/μL, p > 0.05, respectively) in patients with levels between 10 and 30 μg/mL; decreased by 2 × 103/μL from baseline (265 ± 63 vs 267 × 103/μL, p > 0.05, respectively) in patients with levels between 31 and 50 μg/mL, and decreased by 48 × 103/μL from baseline (215 ± 56 vs 263 × 103/μL, p < 0.05, respectively) in patients with levels >50 μg/mL.ConclusionA mean serum total concentration lower than the currently accepted therapeutic level (50–100 µg/mL) may have the same effectiveness in maintaining alcohol abstinence with a lower risk of presenting side effects.

The Use of Anticonvulsant Adjuncts to Treat Alcohol Withdrawal Syndrome in Older Adults

“…Moreover, we are unclear why divalproex was continued in three patients post-discharge, as we could only find one small observational study supporting protracted treatment with valproate in AUD. ( 33 ) Conversely, in large placebo-controlled RCTs, the evidence for protracted treatment with gabapentin for relapse prevention is somewhat stronger, albeit conflicting. ( 30 , 34 , 35 ) It can be helpful for relapse-triggering insomnia, anxiety or dysphoria, ( 36 ) but it can also lead to dizziness, ataxia, somnolence, and misuse.…”

Clinical Significance of Gamma-Glutamyltranspeptidase Combined with Carbohydrate-Deficient Transferrin for the Assessment of Excessive Alcohol Consumption in Patients with Alcoholic Cirrhosis

“…Serum CDT% levels were measured with an N Latex CDT direct immunonephelometric assay (Siemens Healthcare Diagnostics, Marburg, Germany), a monoclonal antibody-based direct immunoassay that identifies the structure of transferrin glycoforms with a shortage of one or two complete N-glycans that correspond to disialo-, monosialo-, and asialo-transferrins (CDT glycoforms) [ 21 ]. Concomitant measurements of total transferrin with a direct immunonephelometric assay using polyclonal antibodies (Siemens Healthcare Diagnostics, Japan), conducted on the same instrument, can automatically determine relative CDT concentrations expressed as the percentage of the total transferrin concentration (%CDT).…”

Clinical and diagnostic value of alcohol biomarkers

“…В исследованиях показана возможность его применения для контроля процесса реабилитации и контроля абстиненции у пациентов с алкогольной зависимостью, при этом этот маркер наиболее специфичен для мониторинга рецидивов. УДТ так же был предложен как маркер для выявления пациентов с высоким риском алкогольного делирия [53,54,55].…”