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Théate N, Geoffroy M, Kanagaratnam L, Gozalo C, Charlot I, Bolko L, Hittinger-Roux A, Djerada Z, Salmon JH. Urinary methotrexate dosage in rheumatoid arthritis, in patients treated for at least 6 months: a potential marker of adherence. RMD Open 2024; 10:e004024. [PMID: 38772677 DOI: 10.1136/rmdopen-2023-004024] [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: 12/18/2023] [Accepted: 04/28/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES Non-adherence to rheumatoid arthritis (RA) treatments must be identified. A methotrexate (MTX) urinary dosage (METU) was recently developed. The aim of our study was to assess adherence to MTX in RA using METU in real-life conditions and to compare it with indirect adherence measurement technics. METHODS We performed a cross-sectional study at Reims University Hospital. We included over 18-year-old patients with RA treated by MTX for more than 6 months. Patients were invited to complete demographic, clinical and psychological questionnaires and adherence measurement technics (Compliance Questionnaire of Rheumatology (CQR) and Medication Possession Ratio (MPR)). A urinary sample was collected to measure MTX and information about tolerance was evaluated through Methotrexate Intolerance Severity Score. RESULTS 84 patients were included, 26 using oral MTX, 58 subcutaneous (SC) MTX. Among them, 73% were female, mean age was 61.5 years, MTX mean dose was 15 mg/week and 61.9% were treated by biological DMARDs (Disease Modifying Antirheumatic Drugs). 77 patients (91.7%) were adherent to treatment according to METU, whereas MPR and CQR reported less adherence (69.5% and 61.9%, respectively). MPR and METU were not significantly different in SC MTX users (p=0.059). Non-adherent patients had a higher number of tender joints and C reactive protein value (p<0.05). CONCLUSION This is the first largest study evaluating MTX adherence in patients with RA using a urinary dosage. We identified that indirect adherence measurements did not reflect real-life adherence. It would be appreciable to realise METU, in a new study, in patients with RA with unexplained response to treatment, to consider it before escalating therapeutic strategy.
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Affiliation(s)
- Noémie Théate
- Rhumatologie, Université de Reims Champagne-Ardenne, Reims, France
- Rhumatologie, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Marion Geoffroy
- Rhumatologie, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Lukshe Kanagaratnam
- UR 3797 VieFra, Université de Reims Champagne-Ardenne, Reims, France
- Unité d'Aide Méthodologique, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Claire Gozalo
- UR 3801 PPF, Université de Reims Champagne-Ardenne, Reims, France
- Pharmacologie-Toxicologie, Pôle de Biologie Territoriale, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Isabelle Charlot
- Rhumatologie, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Lois Bolko
- Rhumatologie, Centre Hospitalier Universitaire de Reims, Reims, France
| | | | - Zoubir Djerada
- UR 3801 PPF, Université de Reims Champagne-Ardenne, Reims, France
- Pharmacologie-Toxicologie, Pôle de Biologie Territoriale, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Jean-Hugues Salmon
- Rhumatologie, Université de Reims Champagne-Ardenne, Reims, France
- Rhumatologie, Centre Hospitalier Universitaire de Reims, Reims, France
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2
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Geoffroy M, Gozalo C, Konecki C, Pauvele L, Hittinger A, Theate N, Feliu C, Salmon JH, Djerada Z. A new pharmacokinetic model of urinary methotrexate to assess adherence in rheumatoid arthritis. Biomed Pharmacother 2023; 168:115620. [PMID: 37864897 DOI: 10.1016/j.biopha.2023.115620] [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: 07/26/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Methotrexate (MTX) is the first-line therapy for rheumatoid arthritis (RA). While therapeutic adherence is essential to successful management, no objective MTX assay is currently available. Using population pharmacokinetic modelling (PopPK), our objective was to describe the urinary MTX (MTXu) kinetics in treated patients and to evaluate its abilities to assess the MTX-adherence. METHODS The association between urinary methotrexate level and methotrexate administration was assessed using a generalized linear model. Then, a population pharmacokinetic model was developed based on data from 59 patients using with Monolix 2021. R2. Simulations were run to establish a reference kinetic profile and evaluate the proportion of samples predicted as true positives. RESULTS Compared to the control group, multivariate analysis showed that MTXu was independently associated with methotrexate administration (p < 0.0001) with a sensitivity and specificity greater than 99%. The final PopPK model selected was a two-compartment model with first-order absorption and elimination. Internal and external validation of the model met all predefined criteria. When using an analytical assay with a LOQ equal to 1 nM, the proportion of samples predicted as true positives is over 90%, as a function of MTX dose (7.5-25 mg/week) and post-administration sampling days (1-7 days). CONCLUSION We developed a pharmacokinetic model able to describe expected patterns of urinary methotrexate. This allowed us to propose a new objective test of MTX adherence, which could help in routine practice to differentiate patients who are truly unresponsive to methotrexate from those who are unresponsive because of non-adherence.
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Affiliation(s)
| | - Claire Gozalo
- Reims University Hospital, Department of Pharmacology and Toxicology, 51100 Reims, France; University of Reims Champagne-Ardenne (URCA), Department of Medical Pharmacology, EA3801, 51097 Reims, France
| | - Céline Konecki
- Reims University Hospital, Department of Pharmacology and Toxicology, 51100 Reims, France; University of Reims Champagne-Ardenne (URCA), Department of Medical Pharmacology, EA3801, 51097 Reims, France
| | - Loic Pauvele
- Rheumatology, CHU Maison Blanche, Reims, Reims, France
| | | | - Noemie Theate
- Rheumatology, CHU Maison Blanche, Reims, Reims, France
| | - Catherine Feliu
- Reims University Hospital, Department of Pharmacology and Toxicology, 51100 Reims, France; University of Reims Champagne-Ardenne (URCA), Department of Medical Pharmacology, EA3801, 51097 Reims, France
| | | | - Zoubir Djerada
- Reims University Hospital, Department of Pharmacology and Toxicology, 51100 Reims, France; University of Reims Champagne-Ardenne (URCA), Department of Medical Pharmacology, EA3801, 51097 Reims, France.
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Cafaro A, Conti M, Pigliasco F, Barco S, Bandettini R, Cangemi G. Biological Fluid Microsampling for Therapeutic Drug Monitoring: A Narrative Review. Biomedicines 2023; 11:1962. [PMID: 37509602 PMCID: PMC10377272 DOI: 10.3390/biomedicines11071962] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Therapeutic drug monitoring (TDM) is a specialized area of laboratory medicine which involves the measurement of drug concentrations in biological fluids with the aim of optimizing efficacy and reducing side effects, possibly modifying the drug dose to keep the plasma concentration within the therapeutic range. Plasma and/or whole blood, usually obtained by venipuncture, are the "gold standard" matrices for TDM. Microsampling, commonly used for newborn screening, could also be a convenient alternative to traditional sampling techniques for pharmacokinetics (PK) studies and TDM, helping to overcome practical problems and offering less invasive options to patients. Although technical limitations have hampered the use of microsampling in these fields, innovative techniques such as 3-D dried blood spheroids, volumetric absorptive microsampling (VAMS), dried plasma spots (DPS), and various microfluidic devices (MDS) can now offer reliable alternatives to traditional samples. The application of microsampling in routine clinical pharmacology is also hampered by the need for instrumentation capable of quantifying analytes in small volumes with sufficient sensitivity. The combination of microsampling with high-sensitivity analytical techniques, such as liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS), is particularly effective in ensuring high accuracy and sensitivity from very small sample volumes. This manuscript provides a critical review of the currently available microsampling devices for both whole blood and other biological fluids, such as plasma, urine, breast milk, and saliva. The purpose is to provide useful information in the scientific community to laboratory personnel, clinicians, and researchers interested in implementing the use of microsampling in their routine clinical practice.
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Affiliation(s)
- Alessia Cafaro
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Matteo Conti
- Public Health Department, Imola Local Unit, Regione Emilia-Romagna Healthcare Service, 40026 Imola, Italy
| | - Federica Pigliasco
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Sebastiano Barco
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Roberto Bandettini
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Giuliana Cangemi
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
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4
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Han Y, Li XL, Zhang M, Wang J, Zeng S, Min JZ. Potential use of a dried saliva spot (DSS) in therapeutic drug monitoring and disease diagnosis. J Pharm Anal 2022; 12:815-823. [PMID: 36605582 PMCID: PMC9805949 DOI: 10.1016/j.jpha.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 01/07/2023] Open
Abstract
In recent years, scientific researchers have increasingly become interested in noninvasive sampling methods for therapeutic drug monitoring and disease diagnosis. As a result, dried saliva spot (DSS), which is a sampling technique for collecting dried saliva samples, has been widely used as an alternative matrix to serum for the detection of target molecules. Coupling the DSS method with a highly sensitive detection instrument improves the efficiency of the preparation and analysis of biological samples. Furthermore, dried blood spots, dried plasma spots, and dried matrix spots, which are similar to those of the DSS method, are discussed. Compared with alternative biological fluids used in dried spot methods, including serum, tears, urine, and plasma, saliva has the advantage of convenience in terms of sample collection from children or persons with disabilities. This review aims to provide integral strategies and guidelines for dried spot methods to analyze biological samples by illustrating several dried spot methods. Herein, we summarize recent advancements in DSS methods from June 2014 to March 2021 and discuss the advantages and disadvantages of the key aspects of this method, including sample preparation and method validation. Finally, we outline the challenges and prospects of such methods in practical applications.
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Affiliation(s)
- Yu Han
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Department of Pharmaceutical Analysis, College of Pharmacy, Yanbian University, Yanji, Jilin, 133002, China
| | - Xi-Ling Li
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Department of Pharmaceutical Analysis, College of Pharmacy, Yanbian University, Yanji, Jilin, 133002, China
| | - Minghui Zhang
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Department of Pharmaceutical Analysis, College of Pharmacy, Yanbian University, Yanji, Jilin, 133002, China
| | - Jing Wang
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Department of Pharmaceutical Analysis, College of Pharmacy, Yanbian University, Yanji, Jilin, 133002, China
| | - Su Zeng
- Institute of Drug Metabolism and Pharmaceutical Analysis, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China
- Corresponding author.
| | - Jun Zhe Min
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Department of Pharmaceutical Analysis, College of Pharmacy, Yanbian University, Yanji, Jilin, 133002, China
- Corresponding author.
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5
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Yang L, Ge J, Ma D, Tang J, Wang H, Li Z. MoS 2 quantum dots as fluorescent probe for methotrexate detection. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 279:121443. [PMID: 35660152 DOI: 10.1016/j.saa.2022.121443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
Herein, we developed a unique fluorescence biosensor for methotrexate assay based on MoS2 quantum dots, which were synthesized in one step using sodium molybdate and cysteine as raw materials. The fluorescence of MoS2 QDs could be quenched when encountered with methotrexate, which was attributed to the inner filter effect (IFE). Furthermore, this present IFE-based method showed the linearity between the MoS2 QDs fluorescence intensity and the methotrexate concentration in the range of 0.05-1 μM with the LOD of 42 nM. The practical applicability of this strategy was successfully demonstrated by detecting methotrexate in real samples. Results indicated that the proposed method could be a promising sensing platform for methotrexate analysis.
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Affiliation(s)
- Like Yang
- College of Chemistry, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, PR China
| | - Jia Ge
- College of Chemistry, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, PR China.
| | - Demiao Ma
- College of Chemistry, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, PR China
| | - Jinlu Tang
- College of Chemistry, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, PR China.
| | - Hongqi Wang
- Institute of Quality Standard and Testing Technology for Agro-products, Henan Academy of Agricultural Science, PR China
| | - Zhaohui Li
- College of Chemistry, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, PR China.
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6
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Szpot P, Wachełko O, Zawadzki M. Toxicological Aspects of Methotrexate Intoxication: Concentrations in Postmortem Biological Samples and Autopsy Findings. TOXICS 2022; 10:572. [PMID: 36287852 PMCID: PMC9609116 DOI: 10.3390/toxics10100572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study was the establishment of a UHPLC-QqQ-MS/MS method to determine methotrexate in postmortem biological samples and quantify the postmortem distribution of methotrexate in a case of fatal intoxication of this drug. A volume of 100 μL or 100 mg of postmortem specimens was precipitated with 400 μL of cold methanol and then analyzed using UHPLC-QqQ-MS/MS. The validation parameters of the method were as follows: limit of quantification: 0.1−1.0 ng/mL or ng/g, coefficient of determination: >0.998 (R2), matrix effect, intra- and inter-day accuracies and precisions: not greater than 13.6%, 14.8% and 17.4%, respectively. The recoveries were: 89.0−113.6%. The postmortem distribution studies revealed methotrexate concentrations as follows: blood—7.2 ng/mL, vitreous humor—0.8 ng/mL, liver—43.7 ng/g, kidney—20.6 ng/g, bone marrow—29.9 ng/g, lumbar vertebra—20.0 ng/g. The highest concentrations of methotrexate after poisoning were found in the tissues with the most rapidly dividing cells. The method described is simple, precise and selective. Methotrexate concentrations can be routinely determined in postmortem specimens. Determination of methotrexate in the postmortem biological material is possible after a few days of intensive treatment.
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Affiliation(s)
- Paweł Szpot
- Department of Forensic Medicine, Wroclaw Medical University, 4 J. Mikulicza-Radeckiego Street, 50345 Wroclaw, Poland
| | - Olga Wachełko
- Institute of Toxicology Research, 45 Kasztanowa Street, 55093 Borowa, Poland
| | - Marcin Zawadzki
- Department of Forensic Medicine, Wroclaw Medical University, 4 J. Mikulicza-Radeckiego Street, 50345 Wroclaw, Poland
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7
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Mei S, Cui Y, Zhang D, Zeng C, Ren X, Yu K, Lin S, Zhao Z. Simultaneous Determination of Urine Methotrexate, 7-Hydroxy Methotrexate, Deoxyaminopteroic Acid, and 7-Hydroxy Deoxyaminopteroic Acid by UHPLC-MS/MS in Patients Receiving High-dose Methotrexate Therapy. ANAL SCI 2020; 36:1479-1486. [PMID: 32801284 DOI: 10.2116/analsci.19p481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nephrotoxicity, the most important toxicity in high-dose methotrexate (MTX) therapy, is partly caused by the formation of crystal deposits in the kidney due to poor water solubility of MTX and its metabolites 7-hydroxy methotrexate (7-OH MTX), deoxyaminopteroic acid (DAMPA) and 7-hydroxy deoxyaminopteroic acid (7-OH DAMPA). Plasma MTX level-guided urine alkalinization, leucovorin rescue and glucarpidase detoxification are common strategies to overcome MTX-related nephrotoxicity. However, overestimation is a problem for MTX analysis by immunoassays due to the cross-reactivity of MTX metabolites (7-OH MTX and DAMPA). An UHPLC-MS/MS method for the simultaneous determination of MTX, 7-OH MTX, DAMPA and 7-OH DAMPA in human urine was developed, validated and applied in clinical practice. Samples were treated by one-step protein precipitation and analyzed within 3 min. The calibration range was 0.02 to 4 μmol/L for MTX and DAMPA, and 0.1 to 20 μmol/L for 7-OH MTX and 7-OH DAMPA. For all analytes, the intra-day and inter-day bias and imprecision were -8.0 to 7.6 and <9.0%, the internal standard normalized recovery and matrix factor were 92.34 to 109.49 and <20.68%. The plasma MTX and 7-OH MTX levels increased with the urine drug levels, age, serum creatinine and alanine transaminase, but urine could not replace blood for MTX monitoring due to their poor correlation (R2, 0.16 to 0.51). Dose-normalized urine and plasma MTX and 7-OH MTX levels were similar between different patient groups (urine pH <7 or ≥7). Due to the large inter-individual variance of the analytes levels in both plasma and urine, these findings should be treated with caution.
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Affiliation(s)
- Shenghui Mei
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University.,Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University
| | - Yong Cui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Dongjie Zhang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University
| | - Chun Zeng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Xiaohui Ren
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Kefu Yu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University.,Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University
| | - Song Lin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University.,Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University
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8
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A review of recent advances in microsampling techniques of biological fluids for therapeutic drug monitoring. J Chromatogr A 2020; 1635:461731. [PMID: 33285415 DOI: 10.1016/j.chroma.2020.461731] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
Conventional sampling of biological fluids often involves a bulk quantity of samples that are tedious to collect, deliver and process. Miniaturized sampling approaches have emerged as promising tools for sample collection due to numerous advantages such as minute sample size, patient friendliness and ease of shipment. This article reviews the applications and advances of microsampling techniques in therapeutic drug monitoring (TDM), covering the period January 2015 - August 2020. As whole blood is the gold standard sampling matrix for TDM, this article comprehensively highlights the most historical microsampling technique, the dried blood spot (DBS), and its development. Advanced developments of DBS, ranging from various automation DBS, paper spray mass spectrometry (PS-MS), 3D dried blood spheroids and volumetric absorptive paper disc (VAPD) and mini-disc (VAPDmini) are discussed. The volumetric absorptive microsampling (VAMS) approach, which overcomes the hematocrit effect associated with the DBS sample, has been employed in recent TDM. The sample collection and sample preparation details in DBS and VAMS are outlined and summarized. This review also delineates the involvement of other biological fluids (plasma, urine, breast milk and saliva) and their miniaturized dried matrix forms in TDM. Specific features and challenges of each microsampling technique are identified and comparison studies are reviewed.
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9
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Hope HF, Hyrich KL, Anderson J, Bluett J, Sergeant JC, Barton A, Cordingley L, Verstappen SMM. The predictors of and reasons for non-adherence in an observational cohort of patients with rheumatoid arthritis commencing methotrexate. Rheumatology (Oxford) 2020; 59:213-223. [PMID: 31302692 DOI: 10.1093/rheumatology/kez274] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/24/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE In order to develop interventions to optimize MTX use for the treatment of RA we evaluated the rate of, reasons for and predictors of MTX non-adherence during the first 6 months of therapy. METHODS The Rheumatoid Arthritis Medication Study (RAMS) is a prospective multicentre cohort study of incident MTX users in the UK. Prior to MTX commencement demographic, clinical and psychological data were collected. A weekly patient-completed diary recorded MTX dose, possible side effects and adherence over 26 weeks. The number of non-adherent weeks was calculated. Potential baseline predictors of ever non-adherence (⩾1 week non-adherent) during the first 6 months of MTX therapy were identified using logistic regression analyses. RESULTS 606 patients with RA were included; 69% female, mean (s.d.) age 60 (13) years and DAS28 score 4.2 (1.2). Over the first 6 months following MTX initiation, 158 (26%) patients were ever non-adherent (71% intentional, 19% non-intentional, 10% unexplained) and mean (s.d.) number of non-adherent weeks was 2.5 (2.1). Multivariable predictors of ever non-adherence included DAS28 [odds ratios (OR) 1.1, 95% CI 1.0, 1.4], fatigue (OR 1.1, 95% CI 1.0, 1.2 per cm), ⩾2 comorbidities vs no comorbidities (OR 1.9, 95% CI 1.1, 3.5) and high medication concerns despite perceived need (OR 1.1, 95% CI 1.0, 1.1 per unit decrease in need/concern differential). CONCLUSION This is the largest study evaluating early intentional and non-intentional non-adherence to MTX, which has identified that patient beliefs and multi-morbidity strongly link with non-adherence. These findings can direct the design of and provide potential targets for interventions to improve patient adherence.
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Affiliation(s)
- Holly F Hope
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kimme L Hyrich
- NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Arthritis Research UK Centre for Epidemiology, Manchester, UK
| | - James Anderson
- Arthritis Research UK Centre for Genetics and Genomics, Faculty of Biology, Medicine and Health, Manchester, UK
| | - James Bluett
- NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Arthritis Research UK Centre for Genetics and Genomics, Faculty of Biology, Medicine and Health, Manchester, UK
| | - Jamie C Sergeant
- Arthritis Research UK Centre for Epidemiology, Manchester, UK.,Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Anne Barton
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Arthritis Research UK Centre for Genetics and Genomics, Faculty of Biology, Medicine and Health, Manchester, UK
| | - Lis Cordingley
- NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Arthritis Research UK Centre for Epidemiology, Manchester, UK
| | - Suzanne M M Verstappen
- NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Arthritis Research UK Centre for Epidemiology, Manchester, UK
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10
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Plant D, Barton A. Adding value to real-world data: the role of biomarkers. Rheumatology (Oxford) 2020; 59:31-38. [PMID: 31329972 PMCID: PMC6909909 DOI: 10.1093/rheumatology/kez113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/28/2019] [Indexed: 12/13/2022] Open
Abstract
Adding biomarker information to real world datasets (e.g. biomarker data collected into disease/drug registries) can enhance mechanistic understanding of intra-patient differences in disease trajectories and differences in important clinical outcomes. Biomarkers can detect pathologies present early in disease potentially paving the way for preventative intervention strategies, which may help patients to avoid disability, poor treatment outcome, disease sequelae and premature mortality. However, adding biomarker data to real world datasets comes with a number of important challenges including sample collection and storage, study design and data analysis and interpretation. In this narrative review we will consider the benefits and challenges of adding biomarker data to real world datasets and discuss how biomarker data have added to our understanding of complex diseases, focusing on rheumatoid arthritis.
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Affiliation(s)
- Darren Plant
- Manchester Academic Health Science Centre, The University of Manchester, Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, UK
- Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Anne Barton
- Manchester Academic Health Science Centre, The University of Manchester, Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, UK
- Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
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11
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Karami F, Ranjbar S, Ghasemi Y, Negahdaripour M. Analytical methodologies for determination of methotrexate and its metabolites in pharmaceutical, biological and environmental samples. J Pharm Anal 2019; 9:373-391. [PMID: 31890337 PMCID: PMC6931080 DOI: 10.1016/j.jpha.2019.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/05/2019] [Accepted: 06/19/2019] [Indexed: 02/08/2023] Open
Abstract
Methotrexate (MTX) is a folate antagonist drug used for several diseases, such as cancers, various malignancies, rheumatoid arthritis (RA) and inflammatory bowel disease. Due to its structural features, including the presence of two carboxylic acid groups and its low native fluorescence, there are some challenges to develop analytical methods for its determination. MTX is metabolized to 7-hydroxymethotrexate (7-OH-MTX), 2,4-diamino-N10-methylpteroic acid (DAMPA), and the active MTX polyglutamates (MTXPGs) in the liver, intestine, and red blood cells (RBCs), respectively. Additionally, the drug has a narrow therapeutic range; hence, its therapeutic drug monitoring (TDM) is necessary to regulate the pharmacokinetics of the drug and to decrease the risk of toxicity. Due to environmental toxicity of MTX; its sensitive, fast and low cost determination in workplace environments is of great interest. A large number of methodologies including high performance liquid chromatography equipped with UV-visible, fluorescence, or electrochemical detection, liquid chromatography-mass spectroscopy, capillary electrophoresis, UV-visible spectrophotometry, and electrochemical methods have been developed for the quantitation of MTX and its metabolites in pharmaceutical, biological, and environmental samples. This paper will attempt to review several published methodologies and the instrumental conditions, which have been applied to measure MTX and its metabolites within the last decade.
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Affiliation(s)
- Forough Karami
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Central Research Laboratory, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Chemistry Department, Yasouj University, Yasouj, Iran
| | - Sara Ranjbar
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Younes Ghasemi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manica Negahdaripour
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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12
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Barbosa AI, Fernandes SR, Machado S, Sousa P, Sze OY, Silva EM, Barreiros L, Lima SA, Reis S, Segundo MA. Fast monolith-based chromatographic method for determination of methotrexate in drug delivery studies. Microchem J 2019. [DOI: 10.1016/j.microc.2019.04.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Avataneo V, D’Avolio A, Cusato J, Cantù M, De Nicolò A. LC-MS application for therapeutic drug monitoring in alternative matrices. J Pharm Biomed Anal 2019; 166:40-51. [DOI: 10.1016/j.jpba.2018.12.040] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 12/14/2022]
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14
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Serrano LA, Yang Y, Salvati E, Stellacci F, Krol S, Guldin S. pH-Mediated molecular differentiation for fluorimetric quantification of chemotherapeutic drugs in human plasma. Chem Commun (Camb) 2018; 54:1485-1488. [PMID: 29359205 DOI: 10.1039/c7cc07668a] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
At present, drug dosage is based on standardised approaches that disregard pharmakokinetic differences between patients and lead to non-optimal efficacy and unnecessary side effects. In this work, we demonstrate the potential of pH-mediated fluorescence spectroscopy for therapeutic drug monitoring in complex media. We apply this principle to the simultaneous quantification of the chemotherapeutic prodrug Irinotecan and its active metabolite SN-38 from human plasma across the clinically relevant concentration range, i.e. from micromolar to nanomolar at molar ratios of up to 30 : 1.
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Affiliation(s)
- Luis A Serrano
- Department of Chemical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
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15
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Booth MA, Gowers SAN, Leong CL, Rogers ML, Samper IC, Wickham AP, Boutelle MG. Chemical Monitoring in Clinical Settings: Recent Developments toward Real-Time Chemical Monitoring of Patients. Anal Chem 2017; 90:2-18. [PMID: 29083872 DOI: 10.1021/acs.analchem.7b04224] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Marsilea A Booth
- Department of Bioengineering, Imperial College London , London, SW7 2AZ, United Kingdom
| | - Sally A N Gowers
- Department of Bioengineering, Imperial College London , London, SW7 2AZ, United Kingdom
| | - Chi Leng Leong
- Department of Bioengineering, Imperial College London , London, SW7 2AZ, United Kingdom
| | - Michelle L Rogers
- Department of Bioengineering, Imperial College London , London, SW7 2AZ, United Kingdom
| | - Isabelle C Samper
- Department of Bioengineering, Imperial College London , London, SW7 2AZ, United Kingdom
| | - Aidan P Wickham
- Department of Bioengineering, Imperial College London , London, SW7 2AZ, United Kingdom
| | - Martyn G Boutelle
- Department of Bioengineering, Imperial College London , London, SW7 2AZ, United Kingdom
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16
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A review of high performance liquid chromatographic-mass spectrometric urinary methods for anticancer drug exposure of health care workers. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1060:316-324. [PMID: 28654869 DOI: 10.1016/j.jchromb.2017.06.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/14/2017] [Accepted: 06/17/2017] [Indexed: 12/15/2022]
Abstract
This review describes published high performance liquid chromatography/mass spectrometry (HPLC-MS) methods for the determination of anticancer drugs in human urine as non-invasive tool for monitoring of health care worker exposure to antineoplastic and cytotoxic drugs. HPLC-MS is a sensitive and specific method for analysis of anticancer drugs and their metabolites in biological fluids. In this review, a tabular summary and overview of published HPLC-MS methods are presented, as well as future trends and limitations in this area of research.
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17
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Subaihi A, Trivedi DK, Hollywood KA, Bluett J, Xu Y, Muhamadali H, Ellis DI, Goodacre R. Quantitative Online Liquid Chromatography–Surface-Enhanced Raman Scattering (LC-SERS) of Methotrexate and its Major Metabolites. Anal Chem 2017; 89:6702-6709. [DOI: 10.1021/acs.analchem.7b00916] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Abdu Subaihi
- School
of Chemistry, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN, U.K
| | - Drupad K. Trivedi
- School
of Chemistry, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN, U.K
| | - Katherine A. Hollywood
- School
of Chemistry, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN, U.K
| | - James Bluett
- Arthritis
Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal
Research, The University of Manchester, Manchester M13 9PT, U.K
- NIHR
Manchester Musculoskeletal BRU, Central Manchester Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, M13 9WU, U.K
| | - Yun Xu
- School
of Chemistry, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN, U.K
| | - Howbeer Muhamadali
- School
of Chemistry, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN, U.K
| | - David I. Ellis
- School
of Chemistry, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN, U.K
| | - Royston Goodacre
- School
of Chemistry, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN, U.K
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18
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HLA-A 31:01 is not associated with the development of methotrexate pneumonitis in the UK population: results from a genome-wide association study. Ann Rheum Dis 2017; 76:e51. [DOI: 10.1136/annrheumdis-2017-211512] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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19
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Guichard N, Guillarme D, Bonnabry P, Fleury-Souverain S. Antineoplastic drugs and their analysis: a state of the art review. Analyst 2017; 142:2273-2321. [DOI: 10.1039/c7an00367f] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We provide an overview of the analytical methods available for the quantification of antineoplastic drugs in pharmaceutical formulations, biological and environmental samples.
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Affiliation(s)
- Nicolas Guichard
- Pharmacy
- Geneva University Hospitals (HUG)
- Geneva
- Switzerland
- School of Pharmaceutical Sciences
| | - Davy Guillarme
- School of Pharmaceutical Sciences
- University of Geneva
- University of Lausanne
- Geneva
- Switzerland
| | - Pascal Bonnabry
- Pharmacy
- Geneva University Hospitals (HUG)
- Geneva
- Switzerland
- School of Pharmaceutical Sciences
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20
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Patel H, Giri P, Ghoghari A, Delvadia P, Syed M, Srinivas NR. Review of the bioanalytical methods for the determination of methotrexate and its metabolites inin vitro, preclinical and clinical studies: Case studies and perspectives. Biomed Chromatogr 2016; 31. [DOI: 10.1002/bmc.3849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/31/2016] [Accepted: 09/06/2016] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | | | - Muzeeb Syed
- Department of Pharmacy, Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
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21
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Garg NK, Sharma G, Singh B, Nirbhavane P, Katare OP. Quality by Design (QbD)-Based Development and Optimization of a Simple, Robust RP-HPLC Method for the Estimation of Methotrexate. J LIQ CHROMATOGR R T 2015. [DOI: 10.1080/10826076.2015.1087409] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Neeraj K. Garg
- Drug Delivery Research Group, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India
| | - Gajanand Sharma
- Drug Delivery Research Group, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India
- Formulation Research, Ipca Laboratories Limited, Kandivli Industrial Estate Ltd., Kandivli (W), Mumbai, Maharashtra, India
| | - Bhupinder Singh
- Drug Delivery Research Group, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India
| | - Pradip Nirbhavane
- Drug Delivery Research Group, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India
| | - Om Prakash Katare
- Drug Delivery Research Group, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India
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