Gabapentin improves parosmia after COVID-19 infection.
Gabapentin improves parosmia after COVID-19 infection.
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加巴喷丁可改善 COVID-19 感染后的嗅觉异常。
DOI：
10.1002/alr.23117
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发表时间：
2023
影响因子：
6.4
通讯作者：
Cho,Do-Yeon
中科院分区：
文献类型：
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作者：
Garcia,JaimeAPena;Miller,Emily;Norwood,TimothyG;Dorin,NatalieA;Grayson,Jessica;Woodworth,Bradford;Cho,Do-Yeon
2.方法本研究由伯明翰的亚拉巴马大学的机构审查委员会批准。对2021年8月至2022年2月期间在亚拉巴马大学口腔和味觉诊所访问单一提供者（DYC）的患者的医疗记录进行了审查。宾夕法尼亚大学嗅觉识别测试（UPSIT）用于检测嗅觉功能障碍（OD），并通过患者的病史确定嗅觉异常。7例患者包括COVID-19感染后具有嗅觉倒错和至少6个月OD史且UPSIT评分异常的患者。滴定方案开始时为每日100 mg，持续7天，随后为每日200 mg，持续7天。根据症状改善和耐受性，剂量增加100 - 300 mg，每周一次，如有必要，可增加至每日600 mg。指导所有受试者每天进行布地奈德（0.5 mg/2 ml混悬液）鼻窦冲洗和嗅觉训练（OT），使用四种精油（柠檬油、玫瑰油、桉树油、薄荷油）。在最大耐受剂量（MTD）治疗至少3周后进行电话访谈。通过电话访谈，通过患者报告的无、轻度、中度或显著改善量表评估对治疗的反应。在研究期间，共有85名新的PVOD患者访问了Taste和Taste诊所。在这85例患者中，14例患者（16.5%，男性与女性= 1：13，平均年龄41.2 [16-67]岁，平均治疗前UPSIT评分= 20.9±7.5）将嗅觉异常确定为COVID-19感染后的主要主诉。加巴喷丁被处方给12名患者，其中两名决定推迟治疗。在这12名患者中，2名患者由于滴定期间的副作用（嗜睡）而不耐受药物，1名患者（男性）因MTD治疗少于3周而被排除。4例患者（44.4%）在开始加巴喷丁治疗前已接受每日布地奈德冲洗和OT治疗。在接受MTD治疗超过3周的9例患者中，8例患者（88.9%）出现改善（表1）。所有9名患者在电话采访中证实了他们对每日布地奈德冲洗和OT的依从性。6例（66.7%）嗅觉异常患者有明显改善。该队列表明在MTD治疗3周内观察到改善。一名患者表现出气味改变（除恶臭外），但未表现出改善。治疗后UPSIT评估仅在该队列的3例患者中可用，这些患者的评分没有改善或改善极小，但报告嗅觉异常有显著改善。当这三名患者中的两名试图逐渐减少剂量时，他们注意到他们的嗅觉异常显著恶化。目前，共有50%的反应患者仍在接受MTD治疗，获益极佳。此外，作用持续时间短，所有有反应的患者在开始用药后几天内主观改善，表明嗅觉异常的缓解可能来自加巴喷丁。
2. METHODSThis study was approved by the Institutional Review Board of the University of Alabama at Birmingham. The medical records of patients visiting a single provider (DYC) in the University of Alabama Smell and Taste Clinic between August 2021 and February 2022 were reviewed. The University of Pennsylvania Smell Identification Test (UPSIT) was used to detect olfactory dysfunction (OD), and parosmia was identified through the patient's history. 7 Patients included those with parosmia and at least a 6 month history of OD with abnormal UPSIT scores following COVID‐19 infection. The titration schedule started with 100 mg daily for 7 days, followed by 200 mg daily for another 7 days. Based on symptomatic improvement and tolerance, the dosage was increased by 100 to 300 mg weekly, if necessary, up to 600 mg daily. All subjects were instructed to perform daily budesonide (0.5 mg/2 ml suspension) sinus irrigation and olfactory training (OT) with four essential oils (lemon, rose, eucalyptus, clove). Phone interviews were performed after a minimum of 3 weeks of treatment at the maximal tolerable dosage (MTD). Responsiveness to treatment was assessed by a patient‐reported scale of no, mild, moderate, or significant improvement via phone interviews.3. RESULTSA total of 85 new patients with PVOD visited the Smell and Taste Clinic during the study period. Of those 85 patients, 14 patients (16.5%, male to female= 1: 13, mean age 41.2 [16–67] years, mean pretreatment UPSIT score= 20.9±7.5) identified parosmia as a major complaint after COVID‐19 infection. Gabapentin was prescribed to 12 patients as two decided to postpone treatment. Of those 12 patients, two did not tolerate the medication due to side effects (drowsiness) during titration, and one patient (male) was excluded as the treatment was less than 3 weeks at MTD. Four patients (44.4%) were already on daily budesonide irrigation and OT before starting gabapentin. Of the nine patients who took more than 3 weeks of treatment at MTD, an improvement was noticed in eight patients (88.9%)(Table 1). All nine patients confirmed their compliance with daily budesonide irrigation and OT during the phone interview. Significant improvement was noticed in six patients (66.7%) who had foul smell as the nature of parosmia. This cohort indicated improvement was noticed within 3 weeks of treatment at MTD. One patient who expressed an altered smell (other than foul) did not demonstrate improvement. Posttreatment UPSIT assessment was only available in three patients from this cohort, who had no or minimal improvement in their scores yet reported significant improvement in parosmia. When two of these three patients tried to taper the dosage, they noted a significant worsening of their parosmia. A total of 50% of responsive patients currently remain on MTD with excellent benefits. Moreover, the short duration of action, where all patients who responded had subjective improvement within several days of starting the medication, indicates the mitigation of parosmia was likely from gabapentin.