Immunoassays in Therapeutic Drug Monitoring

Model-informed precision dosing: State of the art and future perspectives

Model-informed precision dosing (MIPD) stands as a significant development in personalized medicine to tailor drug dosing to individual patient characteristics. MIPD moves beyond traditional therapeutic drug monitoring (TDM) by integrating mathematical predictions of dosing, and considering patient-specific factors (patient characteristics, drug measurements) as well as different sources of variability. For this purpose, rigorous model qualification is required for the application of MIPD in patients. This review delves into new methods in model selection and validation, also highlighting the role of machine learning in improving MIPD, the utilization of biosensors for real-time monitoring, as well as the potential of models integrating biomarkers for efficacy or toxicity for precision dosing. The clinical evidence of TDM and MIPD is discussed for various medical fields including infection medicine, oncology, transplant medicine, and inflammatory bowel diseases, thereby underscoring the role of pharmacokinetics/pharmacodynamics and specific biomarkers. Further research, particularly randomized clinical trials, is warranted to corroborate the value of MIPD in enhancing patient outcomes and advancing personalized medicine.

24/7 Therapeutic Drug Monitoring of Beta-Lactam Antibiotics with CLAM-2000

BACKGROUND

The aim of this study was to evaluate the CLAM-2000 automated preanalytical sample preparation module with integrated liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) as a method for 24/7 therapeutic drug monitoring (TDM) of beta-lactam antibiotics in routine clinical diagnostics.

METHODS

Method validation was performed using quality control samples. Method comparison was performed with routine samples from patients treated with beta-lactam antibiotics.

RESULTS

The determination of piperacillin, meropenem, ceftazidime, flucloxacillin, and cefotaxime was performed using D5-piperacillin and D6-meropenem as internal standards. The linearity of the method was within the therapeutic range of beta-lactam antibiotics. The imprecision and accuracy data obtained from quality control samples were within 15%, and the imprecision of patient samples on the instrument was less than the 5% coefficient of variation (CV). Internal standards stored in the instrument at 9 °C for at least one week were stable, which facilitated reagent use and storage.

CONCLUSION

The CLAM-2000 (Shimadzu, Kyoto, Japan) provides reproducible results as an established routine instrument and is a useful tool for 24/7 TDM of beta-lactam antibiotics in routine clinical diagnostics.

LC–MS3 Strategy for Quantification of Carbamazepine in Human Plasma and Its Application in Therapeutic Drug Monitoring

This study developed a detection method based on the strategy of HPLC/MS³ and verified its suitability by quantifying carbamazepine in human plasma. The high-performance liquid chromatography–tandem mass spectrometry (HPLC/MS³) system was performed using a Shimadzu UFLC XR liquid chromatography and a SCIEX QTRAP^® 5500 linear ion trap triple quadrupole mass spectrometer. The specific operation was as follows: the sample protein was firstly precipitated using methanol, then carbamazepine and carbamazepine-D₂N¹⁵ were separated on an ACQUITY UPLC HSS T3 column using the gradient elution with solvent A (0.1% formic acid) and solvent B (0.1% formic acid in acetonitrile) at a flow rate of 0.25 mL/min. Each sample was run for 7 min. This method was validated for various parameters including accuracy, precision, selectivity, linearity, LLOQ, etc. Only 5 μL of sample plasma could obtain the result of LLOD 0.5 µg/mL. The intra-day and inter-day precision was <8.23%, and accuracy was between −1.74% and 2.92%. This method was successfully used for monitoring the blood concentration of epilepsy patients after carbamazepine treatment.

Development of an immunoassay for monitoring the levels of ciprofloxacin in patient samples

It has been traditional to measure drug concentrations using high pressure liquid chromatography (HPLC). While this method is highly accurate, it is time consuming and requires the use of appropriate standards for identification of the compound. In addition, identification and quantification of drugs from patient samples requires significant manipulation to remove protein. In contrast, enzyme-linked immunoassays (EIA) are able to assay samples with a high degree of specificity, and are able to process multiple samples at a time. In addition, serum proteins do not interfere with sample quantification and samples may be tested without significant preparation. We describe the development of an EIA for the detection of ciprofloxacin in serum and dialysate samples. The immunoassay is specific for ciprofloxacin and is sensitive for picogram amounts of the antibiotic.

Analytical challenges to the pharmaceutical industry in developing products of biotechnology

Problems associated with the analysis of peptides and proteins in pharmaceutical products produced by biotechnology are discussed. Analytical techniques for the determination of peptides and proteins in such products are classified into four categories: bioassays, binding assays, enzyme assays and physical/chemical methods.