UHPLC-MS/MS Method for Determination of Hydroxychloroquine and Its Main Metabolites in Oral Fluid and Whole Blood for Therapeutic Drug Monitoring

Assessment of hydroxychloroquine blood levels in Sjögren's disease patients: drug adherence and clinical associations

Hydroxychloroquine (HCQ) has been used to treat Sjögren's disease (SjD) patients. However, there are no studies evaluating drug adherence through HCQ blood levels, pharmacy refill (PR) and medication adherence questionnaires. The relationship of HCQ blood levels with glandular/extraglandular disease parameters was also poorly assessed. This cross-sectional observational study included 74 adult SjD patients, who were receiving a stable HCQ dose (4-5.5 mg/kg/day, actual weight) for at least 3 months before study inclusion. HCQ blood levels were quantified by high-performance liquid chromatography coupled to mass spectrometry. Adherence was assessed by PR and Medida de Adesão aos Tratamentos (MAT) questionnaire. The following parameters were evaluated: Xerostomia Inventory, Ocular Surface Disease Index, EULAR (European League Against Rheumatism) Sjögren's Syndrome Disease Activity Index, EULAR Sjögren's Syndrome Patient Reported Index, Schirmer's I test and non-stimulated/stimulated salivary flow rates. HCQ blood levels were 775.3(25.0-2,568.6)ng/mL. Eleven patients (14.9%) had HCQ blood levels < 200ng/mL (non-adherent group); 11(14.9%), 200-499ng/mL (sub-therapeutic levels group); and 52(70.2%), ≥ 500ng/mL (adherent group). PR classified incorrectly all non-adherent/sub-therapeutic patients and 2/52(3.9%) adherent patients. Using MAT, the overall misclassification was 24/52(46.2%) in the adherent group, and were correctly identified 9/11(81.8%) patients in non-adherent and 7/11(63.6%) in sub-therapeutic groups. MAT sensitivity and specificity to identify non-adherent/sub-therapeutic patients were 72.7% and 53.9%, respectively. The three groups were comparable regarding glandular/extraglandular disease parameters (p > 0.05). The assessment of HCQ blood levels is a promising tool for evaluating drug adherence in SjD. This is particularly crucial as one-third of patients exhibited non-adherence/sub-therapeutic levels, and neither PR nor MAT reliably identified these patients.

Various techniques for resolving overlapping ultraviolet spectra of combination pharmaceutical dosage forms containing hydroxychloroquine and paracetamol

Ten novel spectrophotometric approaches were developed for the initial examination of the Hydroxychloroquine and Paracetamol medications. These procedures are straightforward, specific, easy to use, and provide exact and accurate results. The determination was conducted through the utilization of several approaches, including zero order (dual wavelength, zero crossing, advanced absorption subtraction and spectrum subtraction), derivative (first derivative of zero crossing), ratio (ratio difference, ratio derivative) and mathematical (bivariate, simultaneous equation, and Q-absorbance) techniques. After undergoing validation in accordance with ICH criteria, it was established that each of these methods achieved acceptable levels of precision, repeatability, robustness, and accuracy. The advantages and disadvantages of each method are demonstrated, and the proposed and reported methodologies were statistically compared.

The ecological impact of liquid chromatographic methods reported for bioanalysis of COVID-19 drug, hydroxychloroquine: Insights on greenness assessment

Hydroxychloroquine is a drug that has been widely used during the early stages of COVID-19 pandemic. Different liquid chromatographic methods have been reported for the analysis of hydroxychloroquine in various biological matrices such as human plasma, serum, whole blood, oral fluid, rat plasma and tissues . In this comparative study, the most popular tools used for assessing the greenness profile: National Environmental Methods Index (NEMI), Eco-Scale Assessment (ESA), Green Analytical Procedure Index (GAPI) and Analytical Greenness metric (AGREE) were utilized to evaluate the ecological impact of eighteen liquid chromatographic methods developed for the bioanalysis of COVID-19 drug; hydroxychloroquine.

NEMI is the simplest tool for evaluating the greenness profile of developed methods, but it is the least informative approach as all the reported methods had the same NEMI pictograms. On the other hand, GAPI is a dependable tool providing a complete picture about the method greenness starting from sampling until the final determination. ESA and AGREE tools are digitally presented and more easily applied. Therefore, their utilization for greenness assessment is highly recommended. Selection of the highest eco-friendly analytical procedure is of a paramount importance for protecting human health and the environment. Considering the greenness of the analytical procedures is highly recommended before proceeding to routine use in order to minimize the chemical hazards to the environment. The most eco-friendly analytical procedures for the analysis of hydroxychloroquine in biological samples according to ESA, GAPI and AGREE tools will be highlighted and discussed.