Determination of the Optimal Concentration of Valproic Acid in Patients with Epilepsy: A Population Pharmacokinetic-Pharmacodynamic Analysis

PLoS One. 2015 Oct 20;10(10):e0141266. doi: 10.1371/journal.pone.0141266. eCollection 2015.

Abstract

Valproic acid (VPA) is one of the most widely prescribed antiepileptic drugs for the treatment of epileptic seizures. Although it is well known that the doses of VPA and its plasma concentrations are highly correlated, the plasma concentrations do not correlate well with the therapeutic effects of the VPA. In this study, we developed a population-based pharmacokinetic (PK)-pharmacodynamic (PD) model to determine the optimal concentration of VPA according to the clinical characteristics of each patient. This retrospective study included 77 VPA-treated Japanese patients with epilepsy. A nonlinear mixed-effects model best represented the relationship between the trough concentrations of VPA at steady-state and an over 50% reduction in seizure frequency. The model was fitted using a logistic regression model, in which the logit function of the probability was a linear function of the predicted trough concentration of VPA. The model showed that the age, seizure locus, the sodium channel neuronal type I alpha subunit rs3812718 polymorphism and co-administration of carbamazepine, clonazepam, phenytoin or topiramate were associated with an over 50% reduction in the seizure frequency. We plotted the receiver operating characteristic (ROC) curve for the logit(Pr) value of the model and the presence or absence of a more than 50% reduction in seizure frequency, and the areas under the curves with the 95% confidence interval from the ROC curve were 0.823 with 0.793-0.853. A logit(Pr) value of 0.1 was considered the optimal cut-off point (sensitivity = 71.8% and specificity = 80.4%), and we calculated the optimal trough concentration of VPA for each patient. Such parameters may be useful to determine the recommended therapeutic concentration of VPA for each patient, and the procedure may contribute to the further development of personalized pharmacological therapy for epilepsy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Anticonvulsants / pharmacokinetics
  • Anticonvulsants / pharmacology
  • Anticonvulsants / standards
  • Child
  • Child, Preschool
  • Drug Interactions
  • Epilepsy / drug therapy*
  • Epilepsy / epidemiology
  • Epilepsy / genetics*
  • Female
  • Humans
  • Infant
  • Japan / epidemiology
  • Male
  • Models, Statistical
  • NAV1.1 Voltage-Gated Sodium Channel / genetics*
  • Polymorphism, Single Nucleotide / genetics*
  • Precision Medicine*
  • ROC Curve
  • Retrospective Studies
  • Tissue Distribution
  • Valproic Acid / pharmacokinetics*
  • Valproic Acid / pharmacology*
  • Valproic Acid / standards
  • Young Adult

Substances

  • Anticonvulsants
  • NAV1.1 Voltage-Gated Sodium Channel
  • SCN1A protein, human
  • Valproic Acid

Grants and funding

The work was supported in full by grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science and Technology, Japan (http://www.jsps.go.jp/english/index.html) Grant Numbers: 25860117, 26360049 and 15K18925, and in part by a grant from Smoking Research Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.