1
|
Tang T, Luo X, Li N, Li Q, Zhang M, Zeng J, Song H, Li L, Chen W. A developed and validated centrifugal ultrafiltration coupled with high performance liquid chromatography-tandem mass spectrometry method for rapid quantification of unbound lenvatinib in human plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1240:124157. [PMID: 38761468 DOI: 10.1016/j.jchromb.2024.124157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/20/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
In clinical practice, the determination of unbound drug concentration is very important for dose adjustment and toxicity prediction because only the unbound fraction can achieve a pharmacological effect. A fast, sensitive and accurate analytical method of centrifugal ultrafiltration coupled with high performance liquid chromatography-tandem mass spectrometry method was developed and applied to allow the quantification of unbound lenvatinib concentration. The application of linear regression analysis was used to examine the effects of centrifugal force, centrifugal time, and protein content on ultrafiltrate volume (Vu). The results indicated that the centrifugal force and centrifugal time have an influence on Vu that is significantly positive (P < 0.05). This developed method with good linearity (r2 = 0.9996), good accuracy (bias % ≤ 2.24 %), good precision (CV % ≤ 7.10 %), and good recovery (95.46 %-106.46 %) was suitable for routine clinical practice and studies. Particularly, the ultrafiltration membrane had no non-specific binding to lenvatinib. The unbound fractions can be separated in just 15 min. This method was applied to quantify clinical samples and to determine the plasma protein binding and unbound fraction of lenvatinib. This study provides a more effective and promising method for determination of unbound lenvatinib. It could be beneficial to measure the unbound concentration of lenvatinib in personalized medicine and therapeutic drug monitoring in routine clinical practice.
Collapse
Affiliation(s)
- Tiantian Tang
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Xianzhang Luo
- Hepatic Biliary & Pancreatic Cancer Center, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Na Li
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Qiaoqiao Li
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Min Zhang
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Jin Zeng
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Haichi Song
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Lixian Li
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing 400030, China.
| | - Wanyi Chen
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing 400030, China.
| |
Collapse
|
2
|
Rigo-Bonnin R, García-Tejada L, Mas-Bosch V, Imaz A, Manuel Tiraboschi J, Scévola S, Niubó J, Navarro-Alcaraz A, Podzamczer D. Development and validation of equilibrium dialysis UHPLC-MS/MS measurement procedures for total and unbound concentrations of bictegravir, dolutegravir, darunavir and doravirine in human plasma. Application to patients with HIV. Clin Chim Acta 2024; 552:117678. [PMID: 38042460 DOI: 10.1016/j.cca.2023.117678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Fixed-dose combinations of antiretroviral drugs are commonly used to treat HIV infection and therapeutic monitoring is not part of routine clinical practice. However, drug concentrations monitoring might have role in different clinical scenarios as well as for research purposes. This study aimed to develop and validate UHPLC-MS/MS procedures for measuring total and unbound concentrations of bictegravir, dolutegravir, darunavir and doravirine in human plasma. MATERIAL AND METHODS Equilibrium dialysis preceded sample preparation (based on protein precipitation) for measuring unbound antiretroviral concentrations. Chromatographic separations were achieved on an Acquity®-UPLC® HSS™-T3 column (50 mm × 2.1 mm; 1.8 µm) using a non-linear water/acetonitrile gradient containing 0.1 % formic acid at a 0.5 mL/min flow rate. Antiretrovirals were detected by tandem mass spectrometry in positive electrospray ionisation and multiple reaction monitoring modes. RESULTS No significant interferences or carry-over were observed. Imprecisions, absolute relative biases, normalised matrix effects and recoveries were ≤15.0 %, ≤11.1 %, (94.7-104.1)% and (96.7-105.5)%, respectively. Non-linear measuring intervals were observed between (25-10,000) µg/L for total/plasma dialysate concentrations and linearity schemes (1.00-100) µg/L for buffer dialysate concentrations. CONCLUSIONS The UHPLC-MS/MS procedures developed could be used for research purposes and therapeutic drug monitoring of antiretrovirals in routine clinical practice.
Collapse
Affiliation(s)
- Raúl Rigo-Bonnin
- Department of Clinical Laboratory, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Laura García-Tejada
- Department of Clinical Laboratory, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Virgínia Mas-Bosch
- Department of Clinical Laboratory, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arkaitz Imaz
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Manuel Tiraboschi
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sofía Scévola
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Niubó
- Department of Microbiology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Navarro-Alcaraz
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Microbial Genomics Group, IrsiCaixa-Institut de Recerca de la SIDA, Badalona, Spain
| | - Daniel Podzamczer
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; FLScience, Fight Infections Foundation, Badalona, Spain
| |
Collapse
|
3
|
Momper JD, Nikanjam M, Best BM, Mirochnick M, Capparelli EV, Cressey TR. Brief Report: Dolutegravir Plasma Protein Binding and Unbound Concentrations During Pregnancy and Postpartum. J Acquir Immune Defic Syndr 2023; 94:332-336. [PMID: 37884053 PMCID: PMC10686188 DOI: 10.1097/qai.0000000000003281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/24/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Clinical interpretation of the reduced dolutegravir (DTG) plasma concentrations reported during pregnancy is complicated by its high plasma protein binding. Plasma proteins significantly decrease during pregnancy, and understanding changes in DTG protein binding and its therapeutically active unbound concentrations are necessary to evaluate the impact of pregnancy changes on DTG pharmacokinetics. METHODS Retrospective assessment of plasma samples from pregnant women living with HIV enrolled in the International Maternal Pediatric Adolescent AIDS Clinical Trials Network P1026s study receiving 50 mg DTG film-coated tablets once daily as part of clinical care. Unbound and total DTG concentrations were determined predose (C0) and at maximum (Cmax) concentrations during the second trimester (2T), third trimester (3T), and postpartum (PP). Percentage unbound was calculated as the ratio of ultrafiltrate unbound DTG concentration to total DTG concentration. RESULTS Twenty-nine mothers were included for protein binding evaluations; 15, 27, and 23 from the 2T, 3T, and PP, respectively. DTG % unbound for C0 and Cmax were significantly different by stage of pregnancy, with 3T significantly higher compared with PP; 1.02% vs. 0.69% (P = 0.0067) for C0 and 0.76% vs. 0.46% for Cmax (P = 0.0056). Median (IQR) unbound concentrations for C0 were 6.3 (4.7-18.4) for the 2T, 8.0 (5.6-16.9) for the 3T, and 13.3 (8.4-22.7) ng/mL PP, significantly different between 2T and PP (P = 0.0039), but not different between 3T and PP (P = 0.46). CONCLUSION Lower total DTG plasma concentrations during pregnancy coincide with temporal decreases in DTG protein binding, resulting in comparable unbound DTG concentrations during the 3T and PP.
Collapse
Affiliation(s)
- Jeremiah D. Momper
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Mina Nikanjam
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Brookie M. Best
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Mark Mirochnick
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Edmund V. Capparelli
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Tim R. Cressey
- AMS-PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Molecular & Clinical Pharmacology, University of Liverpool, UK
| |
Collapse
|
4
|
Yang P, Zhang X, Zhou C, Zhai S, Wang C, Yang L. Determination of free and total meropenem levels in human plasma and its application for the consistency evaluation of generic drugs. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2023; 37:e9460. [PMID: 36542492 DOI: 10.1002/rcm.9460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
RATIONALE The consistency evaluation of generic drugs is important for the overall reformation of drug registration in China. In this study, we used meropenem as a model drug to explore the key techniques for clinical consistency evaluation by studying the plasma protein binding (PPB) ratio of different preparations. Because the free portion of drug is the effective part in vivo, it is essential to measure the free drug concentration in the circulatory system. Therefore, in this study, a fast and accurate high-performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS) method was developed to determine the total and free concentrations of meropenem in human plasma. METHODS Simple protein precipitation procedures were used for the sample processing assay, and ultrafiltration was implemented for the separation of free drugs. Liquid chromatography separation was performed using a hydrophilic interaction liquid chromatography (HILIC) silica column (2.1 × 50 mm, 3 μm). The mobile phase and sample preparation procedures were optimized. Factors affecting the measurement of free drug concentration were also determined. Nonspecific binding of the ultrafiltration membrane was negligible because the recovery rate for post-ultrafiltration was greater than 96%. RESULTS Under optimal conditions, the drug concentrations were linear from 0.5 to 50 μg/ml for both total and free drug concentrations. The PPB ratio was calculated based on the free and total drug concentrations. The PPB of meropenem varied from 1.4% to 24.2% in different subjects. The validated method was applied to evaluate PPB of four preparations, and the results varied from 6.57 ± 3.19% to 10.40 ± 8.31%. One-way analysis of variance (ANOVA) showed no significant differences between the four preparations. CONCLUSIONS We established a rapid, robust, and reliable method for the determination of total and free meropenem concentrations using LC-MS/MS with ultrafiltration techniques. The method provided a new perspective for the clinical consistency evaluation of generic drugs.
Collapse
Affiliation(s)
- Ping Yang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center of Peking University, Beijing, China
| | - Xianhua Zhang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center of Peking University, Beijing, China
| | - Congya Zhou
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center of Peking University, Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Chen Wang
- National Institute for Food and Drug Control, Beijing, China
| | - Li Yang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center of Peking University, Beijing, China
| |
Collapse
|
5
|
Jain P, Thota A, Saini PK, Raghuvanshi RS. Comprehensive Review on Different Analytical Techniques for HIV 1- Integrase Inhibitors: Raltegravir, Dolutegravir, Elvitegravir and Bictegravir. Crit Rev Anal Chem 2022; 54:401-415. [PMID: 35617468 DOI: 10.1080/10408347.2022.2080493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The advent of HIV-Integrase inhibitors (IN) has marked a significant impact on the lives of HIV patients. Since the launch of the first anti retro-viral drug "Azidothymidine" to the recent advances of IN inhibitors, about 27.4 million people benefit by antiretroviral therapy (ART). The path had been challenging due to many crossroads, leading to the discovery of newer targets. One such recent ART target is Integrase. Use of Integrase inhibitors has surpassed the usage of all other ART owing to a strong barrier to resistance and have been reported to be the first-line therapy. Raltegravir, Elvitegravir, Dolutegravir and Bictegravir are US FDA approved IN inhibitors. The high usage of ART created an opportunity to study various analytical techniques for IN inhibitors. Hitherto, no review encompassing all IN inhibitors is presented. Herein, this review describes the analytical techniques employed for IN inhibitors estimation and quantification reported in the literature and official compendia. Literature suggests that most studies focus on LC-MS/MS and HPLC methods for drug estimation, and few reports suggest spectrophotometric, spectrofluorimetric and electrochemical methods. Furthermore, the review presents the techniques that describe the quantification of integrase drugs in various matrices. Although, antiretroviral drugs are extensively used but data suggests that limited studies have been conducted for determination of impurity profile and stability. This therefore, presents a scope to detect and validate impurities in order to meet ICH guidelines for their limits and further to improve the quality and safety of antiretroviral drugs.
Collapse
Affiliation(s)
- Priti Jain
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Anusha Thota
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Pawan K Saini
- Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Ghaziabad, UP, India
| | | |
Collapse
|
6
|
Ikumi NM, Anumba D, Matjila M. Pharmacokinetics and placental transfer of dolutegravir in pregnancy. J Antimicrob Chemother 2021; 77:283-289. [PMID: 34618029 DOI: 10.1093/jac/dkab365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Dolutegravir is currently recommended by the WHO as the preferred first-line treatment for all people with HIV, including pregnant women. Estimates indicate that, by 2024, nearly 22 million adults in low- and middle-income countries will have transitioned to dolutegravir-based ART. It is therefore critical that there is a clear appreciation and understanding of the risks that may be associated with in utero exposure to dolutegravir. In this review we consolidate data from studies on dolutegravir and the placenta. The studies have largely focused on the pharmacokinetics and placental transfer of dolutegravir in pregnancy. These include studies on transplacental transfer of dolutegravir, ex vivo placenta perfusion models, physiologically based pharmacokinetic (PBPK) models and animal studies. The data available clearly demonstrate that placental transfer of dolutegravir occurs in moderate to high concentrations. Intracellular placental dolutegravir has been demonstrated in the placental villous tissue. There are limited data suggesting that pregnancy is associated with decreased maternal dolutegravir levels. In addition, PBPK models have great potential in predicting the passage of drugs through the placenta and further contributing towards the elucidation of fetal exposure. The animal studies available demonstrate that in utero dolutegravir exposure can be associated with neural tube defects. Taking into consideration that antiretroviral exposure may be associated with poor placental development or function and increased risk of adverse effects to the fetus, it is crucially important that these risks are evaluated, especially with the rapid scale up of dolutegravir-based ART into national treatment programmes.
Collapse
Affiliation(s)
- Nadia M Ikumi
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Dilly Anumba
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, UK
| | - Mushi Matjila
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
7
|
Metsu D, Aquilina C, Delobel P, Gandia P, Savagner F, Raymond S, Caron P, Martin-Blondel G. Maraviroc exposure is influenced by exogenous thyrotoxicosis. AIDS 2021; 35:701-703. [PMID: 33620876 DOI: 10.1097/qad.0000000000002754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David Metsu
- Laboratory of Pharmacokinetics and Toxicology, Purpan Hospital, University Hospital of Toulouse
- INTHERES UMR1436 INRA-ENVT
| | | | - Pierre Delobel
- Department of Infectious Diseases, University Hospital of Toulouse
- Inserm U1043 - CNRS UMR 5282, Toulouse-Purpan Pathophysiology Center
| | - Peggy Gandia
- Laboratory of Pharmacokinetics and Toxicology, Purpan Hospital, University Hospital of Toulouse
- INTHERES UMR1436 INRA-ENVT
| | - Frédérique Savagner
- Biochemistry and Genetic Laboratory, Federative Institute of Biology, CHU Toulouse
- Team 6, Inserm UMR 1048, Institute of Metabolic and Cardiovascular Diseases (I2MC), CHU Rangueil
| | - Stéphanie Raymond
- Inserm U1043 - CNRS UMR 5282, Toulouse-Purpan Pathophysiology Center
- Department of Virology, CHU Purpan
| | - Philippe Caron
- Team 6, Inserm UMR 1048, Institute of Metabolic and Cardiovascular Diseases (I2MC), CHU Rangueil
- Department of Endocrinology and Metabolic Diseases, Pôle Cardiovascular and Metabolic, Larrey University Hospital, Toulouse, France
| | - Guillaume Martin-Blondel
- Department of Infectious Diseases, University Hospital of Toulouse
- Inserm U1043 - CNRS UMR 5282, Toulouse-Purpan Pathophysiology Center
| |
Collapse
|
8
|
Development of a simple and rapid method to determine the unbound fraction of dolutegravir, raltegravir and darunavir in human plasma using ultrafiltration and LC-MS/MS. J Pharm Biomed Anal 2021; 196:113923. [PMID: 33571728 DOI: 10.1016/j.jpba.2021.113923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 11/20/2022]
Abstract
Dolutegravir, raltegravir and darunavir are three antiretroviral drugs widely used in combined antiretroviral therapies. These three drugs are highly bound to plasma proteins. Compared to the total concentration, the concentration of unbound drug which is considered as the only pharmacological active form should be more informative to improve therapeutic drug monitoring in patients to avoid virological failure or toxicity. The aim of the present study was to develop an ultrafiltration protocol and a LC-MS/MS method to simultaneously determine the concentrations of the unbound dolutegravir, raltegravir and darunavir in human plasma. Finally, 150 μL of plasma was ultrafiltrated using Centrifree® ultrafiltration devices with ultracel YM-T membrane (cutoff 30 KDa) during 5 min at 37 °C at 1500 g. Then, 20 μL of the ultrafiltrate were injected into the LC-MS/MS system. The chromatographic separation was carried out on a BEH C18 column using a mobile phase containing deionized water and acetonitrile, both with 0.05 % (v/v) of formic acid, with a gradient elution at a flow rate of 0.5 mL/min. The run time was only 4 min. The calibration curve ranged from 0.5-200 ng/mL for dolutegravir, 1 to 400 ng/mL for raltegravir and 10-4000 ng/mL for darunavir. This method was validated with a good precision (inter- and intra-day CV% lower than 14 %) and a good accuracy (inter- and intra-day bias between -5.6-8.8 %) for all the analytes. This method is simple, reliable and suitable for pharmacokinetic studies.
Collapse
|
9
|
Metsu D, Lanot T, Fraissinet F, Concordet D, Gayrard V, Averseng M, Ressault A, Martin-Blondel G, Levade T, Février F, Chatelut E, Delobel P, Gandia P. Comparing ultrafiltration and equilibrium dialysis to measure unbound plasma dolutegravir concentrations based on a design of experiment approach. Sci Rep 2020; 10:12265. [PMID: 32703975 PMCID: PMC7378073 DOI: 10.1038/s41598-020-69102-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 06/30/2020] [Indexed: 11/30/2022] Open
Abstract
Dolutegravir therapeutic drug monitoring (TDM) could be improved by measuring the unbound dolutegravir plasma concentration (Cu), particularly in patients experiencing virological failure or toxicity despite achieving appropriate DTG total plasma concentrations. Equilibrium dialysis (ED) is the gold standard to measure Cu, but ED is time consuming, precluding its use in clinical practice. In contrast, ultrafiltration is applicable to TDM, but is sensitive to numerous analytical conditions. In order to evaluate measurements of Cu by ultrafiltration, ultrafiltration conditions were validated by comparison with ED. DTG concentrations were measured by LC–MS/MS. Three ultrafiltration factors (temperature, duration and relative centrifugal force [RCF]) were evaluated and compared to ED (25/37 °C), using a design of experiment strategy. Temperature was found to influence Cu results by ED (p = 0.036) and UF (p = 0.002) when results were analysed with ANOVA. Relative centrifugal force (2000 g) and time (20 min) interacted to influence Cu (p = 0.006), while individually they did not influence Cu (p = 0.88 and p = 0.42 for RCF and time). Ultrafiltration conditions which yielded the most comparable results to ED were 37 °C, 1000 g for 20 min. Ultrafiltration results greatly depended on analytical conditions, confirming the need to validate the method by comparison with ED in order to correctly interpret DTG Cu.
Collapse
Affiliation(s)
- David Metsu
- Department of Pharmacokinetics and Toxicology, Toulouse University Hospital, Toulouse, France.,INSERM, CRCT, Toulouse University, UPS, Toulouse, France
| | - Thomas Lanot
- Department of Pharmacokinetics and Toxicology, Toulouse University Hospital, Toulouse, France
| | - François Fraissinet
- Department of Pharmacokinetics and Toxicology, Toulouse University Hospital, Toulouse, France
| | | | | | - Manon Averseng
- Department of Pharmacokinetics and Toxicology, Toulouse University Hospital, Toulouse, France
| | - Alice Ressault
- Department of Pharmacokinetics and Toxicology, Toulouse University Hospital, Toulouse, France
| | - Guillaume Martin-Blondel
- Department of Infectious Diseases, University Hospital of Toulouse, Toulouse, France.,Inserm U1043 - CNRS UMR 5282, Toulouse-Purpan Pathophysiology Center, 31173, Toulouse Cedex, France
| | - Thierry Levade
- Department of Biochemistry, Toulouse University Hospital, Toulouse, France.,INSERM UMR1037, CRCT (Cancer Research Centre of Toulouse), Toulouse University, UPS, Toulouse, France
| | - Frédéric Février
- Department of Laboratory Medicine, GCS Ingres-Quercy, Montauban Hospital, Montauban, France
| | - Etienne Chatelut
- INSERM, CRCT, Toulouse University, UPS, Toulouse, France.,Institut Claudius-Regaud, IUCT-Oncopole, Toulouse, France
| | - Pierre Delobel
- Department of Infectious Diseases, University Hospital of Toulouse, Toulouse, France.,Inserm U1043 - CNRS UMR 5282, Toulouse-Purpan Pathophysiology Center, 31173, Toulouse Cedex, France
| | - Peggy Gandia
- Department of Pharmacokinetics and Toxicology, Toulouse University Hospital, Toulouse, France. .,INTHERES, INRA, ENVT, Toulouse University, Toulouse, France. .,Laboratoire de Pharmacocinétique Et Toxicologie (Pharmacokinetics and Toxicology Laboratory), Centre Hospitalo-Universitaire Purpan (Purpan University Medical Centre), 330 avenue de Grande-Bretagne, 31059, Toulouse, France.
| |
Collapse
|
10
|
Freriksen JJM, Schalkwijk S, Colbers AP, Abduljalil K, Russel FGM, Burger DM, Greupink R. Assessment of Maternal and Fetal Dolutegravir Exposure by Integrating Ex Vivo Placental Perfusion Data and Physiologically-Based Pharmacokinetic Modeling. Clin Pharmacol Ther 2020; 107:1352-1361. [PMID: 31868223 PMCID: PMC7325314 DOI: 10.1002/cpt.1748] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/22/2019] [Indexed: 12/13/2022]
Abstract
Antiretroviral therapy during pregnancy reduces the risk of vertical HIV‐1 transmission. However, drug dosing is challenging as pharmacokinetics (PK) may be altered during pregnancy. We combined a pregnancy physiologically‐based pharmacokinetic (PBPK) modeling approach with data on placental drug transfer to simulate maternal and fetal exposure to dolutegravir (DTG). First, a PBPK model for DTG exposure in healthy volunteers was established based on physiological and DTG PK data. Next, the model was extended with a fetoplacental unit using transplacental kinetics obtained by performing ex vivo dual‐side human cotyledon perfusion experiments. Simulations of fetal exposure after maternal dosing in the third trimester were in accordance with clinically observed DTG cord blood data. Furthermore, the predicted fetal trough plasma concentration (Ctrough) following 50 mg q.d. dosing remained above the concentration that results in 90% of viral inhibition. Our integrated approach enables simulation of maternal and fetal DTG exposure, illustrating this to be a promising way to assess DTG PK during pregnancy.
Collapse
Affiliation(s)
- Jolien J M Freriksen
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stein Schalkwijk
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Angela P Colbers
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Frans G M Russel
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rick Greupink
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
11
|
|