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Raveendran A, Gupta A, Lewis LE, Prabhu K, Moorkoth S. A comprehensive approach for detection of biotin deficiency from dried blood spot samples using liquid chromatography-mass spectrometry. Future Sci OA 2024; 10:2355038. [PMID: 38963009 PMCID: PMC11229587 DOI: 10.1080/20565623.2024.2355038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/24/2024] [Indexed: 07/05/2024] Open
Abstract
Aim: The aim of the present study is to develop a liquid chromatography-mass spectrometry method to measure two important biomarkers of biotin deficiency from dried blood spot samples for effective management of the disorder. Materials & methods: The method was developed on a liquid chromatography-mass spectrometry system using pentafluorophenyl column employing a mobile phase composition of methanol and water in the isocratic mode. A full validation of the method was performed as per relevant guidelines. Results & conclusion: Correlation between the results of dried blood spot and plasma method was evaluated to determine the interconvertibility of the method. The developed method was successfully applied for establishing the reference ranges for these biomarkers in the population of Udupi, a coastal district of South India.
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Affiliation(s)
- Arya Raveendran
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Ashutosh Gupta
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Leslie E Lewis
- Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Krishnananda Prabhu
- Department of Biochemistry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Sudheer Moorkoth
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
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2
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Wang HB, Xiao X, He XY, Wang ST. Advancing towards practice: A novel LC-MS/MS method for detecting retinol in dried blood spots. Talanta 2024; 278:126491. [PMID: 38955103 DOI: 10.1016/j.talanta.2024.126491] [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: 04/16/2024] [Revised: 06/16/2024] [Accepted: 06/28/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND To date, clinical laboratories face challenges in quantifying retinol from DBS samples. Disputes arise throughout the whole detection process, encompassing the storage condition, the release strategy as well as the selection of internal standards. METHODS We incubated DBS with ascorbic acid solution. Then, retinol-d4 in acetonitrile was introduced to incorporate isotopic internal standard and promote protein precipitation. Afterward, sodium carbonate solution was added to ionize cytochromes (such as bilirubin), which amplified the difference of their hydrophobicity to retinol. Subsequently, cold-induced phase separation could be facilitated to separate retinol from the impurities. In the end, the upper layer was injected for LC-MS/MS analysis. RESULTS By comparing the detected retinol content in whole blood and DBS samples prepared from the same volume, we confirmed the established pretreatment was capable to extract most of retinol from DBS (recovery >90 %). Thereafter, we verified that within DBS, retinol possessed satisfying stability without antioxidation. Indoor-light exposure and storage duration would not cause obvious degradation (<10 %). Following systematic validation, the established method well met the criteria outlined in the relevant guidelines. After comparing with detected DBS results to the paired plasma samples, 54 out of 60 met the acceptance limit for cross-validation of ±20 %. CONCLUSIONS We realized precise quantification of retinol from one 3.2 mm DBS disc. By circumventing conventional antioxidation, liquid-liquid/solid-phase extraction and organic solvent evaporation, the pretreatment could be completed within 15 min consuming only minimal amounts of low-toxicity chemicals (ascorbic acid, acetonitrile, and sodium carbonate). We expect this contribution holds the potential to significantly facilitate the evaluation of patients' vitamin A status by using DBS samples in the future.
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Affiliation(s)
- Hai-Bo Wang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xuan Xiao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xiao-Yun He
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Shao-Ting Wang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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3
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Vonk SEM, van der Meer-Vos M, Kos R, Neerincx AH, Terheggen-Lagro SWJ, Altenburg J, Maitland-van der Zee AH, Mathôt RAA, Kemper EM. Dried Blood Spot Method Development and Clinical Validation for the Analysis of Elexacaftor, Elexacaftor-M23, Tezacaftor, Tezacaftor-M1, Ivacaftor, Ivacaftor Carboxylate, and Hydroxymethyl Ivacaftor Using LC-MS/MS. Ther Drug Monit 2024:00007691-990000000-00243. [PMID: 38935410 DOI: 10.1097/ftd.0000000000001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/23/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The highly effective Cystic Fibrosis Transmembrane conductance Regulator (CFTR) modulator, elexacaftor-tezacaftor-ivacaftor, is now widely being used by people with cystic fibrosis. However, few independent studies have detailed the pharmacokinetics (PK) of CFTR modulators. Blood collection by venipuncture is the gold standard for PK measurements, but it is invasive. The aim of this study was to develop and clinically validate a quantification method for elexacaftor, tezacaftor, ivacaftor, and their main metabolites in dried blood spots (DBSs) using liquid chromatography with tandem mass spectrometry. METHODS Linearity, accuracy, precision, stability, hematocrit (Hct), spot-to-spot carryover, spot volume, and extraction efficiency were validated in DBS for all analytes. The clinical validation of elexacaftor-tezacaftor-ivacaftor in patients was performed by comparing 21 DBS samples with matched plasma samples. RESULTS The preset requirements for linearity, within-run and between-run accuracy, precision, Hct, spot volume, and extraction efficiency were met. Puncher carryover was observed and resolved by punching 3 blanks after each sample. The samples remained stable and showed no notable degradation across the tested temperatures and time intervals. Corrected DBS values with the Passing-Bablok regression equation showed good agreement in Bland-Altman plots, and acceptance values were within 20% of the mean for a minimum of 67% of the repeats, according to the EMA guidelines. CONCLUSIONS A quantification method for the analysis of elexacaftor, tezacaftor, ivacaftor, and their main metabolites was developed and clinically validated in DBS. This method could be valuable in both clinical care and research to address unanswered PK questions regarding CFTR modulators.
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Affiliation(s)
- Steffie E M Vonk
- Department of Hospital Pharmacy & Clinical Pharmacology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Marloes van der Meer-Vos
- Department of Hospital Pharmacy & Clinical Pharmacology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Renate Kos
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Anne H Neerincx
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Suzanne W J Terheggen-Lagro
- Department of Pediatric Pulmonology and Allergy, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; and
| | - Josje Altenburg
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Anke H Maitland-van der Zee
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Ron A A Mathôt
- Department of Hospital Pharmacy & Clinical Pharmacology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - E Marleen Kemper
- Department of Hospital Pharmacy & Clinical Pharmacology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Department of Vascular Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
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4
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Besten-Bertholee DD, Wegner I, Touw DJ, Ter Horst PGJ. Analytical and clinical validation of an LC-MS/MS method for carbamazepine, lamotrigine and levetiracetam in dried blood spots. Eur J Hosp Pharm 2024; 31:450-454. [PMID: 36894298 DOI: 10.1136/ejhpharm-2022-003589] [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: 11/11/2022] [Accepted: 02/28/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVES Therapeutic drug monitoring is performed routinely in patients on anti-epileptic drugs (AEDs) for optimisation and individualisation of therapy. The dried blood spot (DBS) sampling technique is a suitable, more patient-friendly alternative for conventional venous sampling methods. However, before DBS can be used in routine care, data are needed to establish the correlation between standard plasma concentrations obtained from venous puncture and concentrations measured through DBS obtained by finger prick. This study aims to investigate the correlation between carbamazepine, lamotrigine and levetiracetam drug concentrations in venous blood and DBS samples in the same patients at the same time. METHODS Clinical validation was conducted by direct comparison of paired DBS and venous plasma samples. Method agreement was evaluated using Passing-Bablok regression analysis and Bland-Altman plots to provide insight into the relationship between the two analytically validated methods. For Bland-Altman analysis the acceptance limit required by both FDA and EMA guidelines is at least two-thirds (67%) of the paired samples within 80-120% of the mean of both methods. RESULTS Paired samples from 79 patients were studied. For all three AEDs, plasma and DBS concentrations correlated highly (r=0.90 for carbamazepine, r=0.93 for lamotrigine and r=0.93 for levetiracetam), indicating a linear relationship. For carbamazepine and lamotrigine, no proportional or constant bias was revealed. For levetiracetam, concentrations were higher in plasma samples than in DBS (slope 1.21), implying a conversion factor is needed. The acceptance limit was met for carbamazepine and levetiracetam with a value of 72% and 81%, respectively. For lamotrigine, this acceptance limit was not met with a value of 60%. CONCLUSIONS The method was successfully validated and will be used for therapeutic drug monitoring in patients using carbamazepine, lamotrigine and/or levetiracetam.
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Affiliation(s)
| | | | - Daan J Touw
- Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Groningen Research Institute of Pharmacy, Section Pharmaceutical Analysis, University of Groningen, Groningen, The Netherlands
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5
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Minichmayr IK, Dreesen E, Centanni M, Wang Z, Hoffert Y, Friberg LE, Wicha SG. Model-informed precision dosing: State of the art and future perspectives. Adv Drug Deliv Rev 2024:115421. [PMID: 39159868 DOI: 10.1016/j.addr.2024.115421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/19/2024] [Accepted: 08/01/2024] [Indexed: 08/21/2024]
Abstract
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.
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Affiliation(s)
- I K Minichmayr
- Dept. of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - E Dreesen
- Clinical Pharmacology and Pharmacotherapy Unit, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - M Centanni
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Z Wang
- Clinical Pharmacology and Pharmacotherapy Unit, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Y Hoffert
- Clinical Pharmacology and Pharmacotherapy Unit, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - L E Friberg
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - S G Wicha
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hamburg, Germany.
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6
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Kocur A, Kot B, Moczulski M, Czajkowska A, Rubik J, Sierakowski M, Pawiński T. A novel approach to therapeutic drug monitoring of Ciclosporin in pediatric renal transplant recipients using volumetric absorptive microsampling (VAMS) - Teaching old dog new tricks. Clin Chim Acta 2024; 562:119877. [PMID: 39025199 DOI: 10.1016/j.cca.2024.119877] [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: 05/28/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND AND AIMS Ciclosporin (CSA) is an immunosuppressive agent that requires therapeutic drug monitoring (TDM). High partitioning in erythrocytes indicates that whole blood (WB) is a suitable matrix for CSA determination. Alternative sampling strategies, such as volumetric absorptive microsampling (VAMS), are novel possibilities for blood collection during TDM for various analytes, including immunosuppressants. This technique is attractive for vulnerable pediatric patients, including home-based self-sampling, remote therapy, and adherence control. MATERIALS AND METHODS This study aimed to develop and validate a new method for CSA determination based on liquid chromatography-tandem mass spectrometry (LC-MS/MS) of WB and VAMS samples. Additionally, these methods were applied for CSA determination in clinical samples from pediatric transplant recipients. A strong point of this study is the assessment of an external proficiency testing scheme. RESULTS Both methods were successfully validated within the 1-2000 ng/mL calibration range, with LOD 0.5 and 1 ng/mL for WB and VAMS methods, respectively. All the validation parameters fulfilled the international acceptance criteria for bioanalytical methods. Cross-validation confirmed the interchangeability of the LC-MS/MS method developed in this study. CONCLUSION This study developed and validated novel methods for CSA determination in whole blood and VAMS using LC-MS/MS. Clinical validation and proficiency testing confirmed their utility in routine clinical practice.
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Affiliation(s)
- Arkadiusz Kocur
- Department of Drug Chemistry, Pharmaceutical and Biomedical Analysis, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland; Therapeutic Drug Monitoring, Clinical Pharmacokinetics and Toxicology Laboratory Unit, Department of Clinical Biochemistry, The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
| | - Bartłomiej Kot
- Student's Scientific Association in the Department of Drug Chemistry, Pharmaceutical and Biomedical Analysis, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Mateusz Moczulski
- Student's Scientific Association in the Department of Drug Chemistry, Pharmaceutical and Biomedical Analysis, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Agnieszka Czajkowska
- Therapeutic Drug Monitoring, Clinical Pharmacokinetics and Toxicology Laboratory Unit, Department of Clinical Biochemistry, The Children's Memorial Health Institute, 04-730 Warsaw, Poland
| | - Jacek Rubik
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, The Children's Memorial Health Institute, Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Maciej Sierakowski
- Institute of Biological Sciences, Cardinal Stefan Wyszynski University, 1/3 Kazimierza Wóycickiego St, 01-938, Warsaw, Poland
| | - Tomasz Pawiński
- Department of Drug Chemistry, Pharmaceutical and Biomedical Analysis, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland
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Rajadhyaksha M, Londhe V. Development of LC-MS/MS method for quantification of Lurasidone using volumetric absorptive microsampling (VAMS); a comparative study between dried blood and plasma samples. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1244:124255. [PMID: 39059319 DOI: 10.1016/j.jchromb.2024.124255] [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: 04/03/2024] [Revised: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 07/28/2024]
Abstract
The ecological impact of biological, chemical, and analytical research practices, including toxic reagents and biohazardous waste, has led to the development of alternative sampling and extraction techniques for bioanalysis. Microsampling (sample volume < 50 µL) aligns with the 3Rs principle, allowing multiple sampling points from the same animal at different time points and improving animal welfare. A bioanalytical method was developed to investigate factors related to bioanalytical challenges and the implementation of microsampling techniques. An LC-MS/MS method for Volumetric Absorptive Microsampling (VAMS), 20 µL, was developed for quantifying Lurasidone using a liquid-liquid extraction technique. The method uses a C18, Phenomenex column for chromatographic separation and a mobile phase composition of Methanol, Acetonitrile, and Water with 0.1 % HFBA. The method was validated over a concentration range of 5.0 to 1200.0 ng/mL and achieved acceptable precision and accuracy. The recovery for analyte from VAMS was approximately 40% at four different concentrations and is consistent (%CV < 15), with no significant differences among HCT levels. The matrix factor ranged between 85.00 and 115.00 %, showing no substantial issues with reduced or enhanced signal. The stability data showed no significant degradation of LUR in VAMS samples when stored at room temperature for 15 days. The newly established method for Lurasidone confirmed the use of VAMS sampling method and its analysis on LC-MS/MS. Further, the data obtained from microsampling techniques was compared with conventional (plasma) technique, as proof-of-concept, and it confirms the agreement between the two methods. The study supports the advantages of microsampling in protecting the environment and animals while maintaining scientific judgement.
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Affiliation(s)
- Madhura Rajadhyaksha
- SPPSPTM, SVKM's Narsee Monjee Institute of Management Studies, V.L. Mehta Road, Vile Parle (W), Mumbai 400056, India; Sitec Labs Ltd. Plot no. Gen-40, TTC, MIDC Behind Millennium Business Park, Near Nelco, Mahape, New Mumbai 400710, India.
| | - Vaishali Londhe
- SPPSPTM, SVKM's Narsee Monjee Institute of Management Studies, V.L. Mehta Road, Vile Parle (W), Mumbai 400056, India
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Kocur A, Czajkowska A, Moczulski M, Kot B, Rubik J, Pawiński T. Assessment of Dried Serum Spots (DSS) and Volumetric-Absorptive Microsampling (VAMS) Techniques in Therapeutic Drug Monitoring of (Val)Ganciclovir-Comparative Study in Analytical and Clinical Practice. Int J Mol Sci 2024; 25:8760. [PMID: 39201447 DOI: 10.3390/ijms25168760] [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: 06/29/2024] [Revised: 08/08/2024] [Accepted: 08/10/2024] [Indexed: 09/02/2024] Open
Abstract
Ganciclovir (GCV) and its prodrug valganciclovir (VGCV) are antiviral medications primarily used to treat infections caused by cytomegalovirus (CMV), particularly in immunocompromised individuals such as solid organ transplant (SOT) recipients. Therapy with GCV is associated with significant side effects, including bone marrow suppression. Therefore, therapeutic drug monitoring (TDM) is mandatory for an appropriate balance between subtherapeutic and toxic drug levels. This study aimed to develop and validate three novel methods based on liquid chromatography-tandem mass spectrometry (LC-MS/MS) for GCV determination in serum (reference methodology), dried serum spots (DSS), and VAMS-Mitra™ devices. The methods were optimized and validated in the 0.1-25 mg/L calibration range. The obtained results fulfilled the EMA acceptance criteria for bioanalytical method validation. Assessment of DSS and VAMS techniques extended GCV stability to serum for up to a minimum of 49 days (at room temperature, with desiccant). Developed methods were effectively evaluated using 80 clinical serum samples from pediatric renal transplant recipients. Obtained samples were used for DSS, and dried serum VAMS samples were manually generated in the laboratory. The results of GCV determination using serum-, DSS- and VAMS-LC-MS/MS methods were compared using regression analysis and bias evaluation. The conducted statistical analysis confirmed the interchangeability between developed assays. The DSS and VAMS samples are more accessible and stable during storage, transport and shipment than classic serum samples.
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Affiliation(s)
- Arkadiusz Kocur
- Department of Drug Chemistry, Pharmaceutical and Biomedical Analysis, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland
| | - Agnieszka Czajkowska
- Therapeutic Drug Monitoring, Clinical Pharmacokinetics and Toxicology Laboratory, Department of Clinical Biochemistry, The Children's Memorial Health Institute in Warsaw, Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Mateusz Moczulski
- Student Scientific Association "Drug" in Department of Drug Chemistry, Pharmaceutical and Biomedical Analysis, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland
| | - Bartłomiej Kot
- Student Scientific Association "Drug" in Department of Drug Chemistry, Pharmaceutical and Biomedical Analysis, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland
| | - Jacek Rubik
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Tomasz Pawiński
- Department of Drug Chemistry, Pharmaceutical and Biomedical Analysis, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland
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9
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Meertens M, de Vries N, Rosing H, Steeghs N, Beijnen JH, Huitema ADR. Analytical Validation of a Volumetric Absorptive Microsampling Method for Therapeutic Drug Monitoring of the Oral Targeted Anticancer Agents, Abiraterone, Alectinib, Cabozantinib, Imatinib, Olaparib, and Sunitinib, and Metabolites. Ther Drug Monit 2024; 46:494-502. [PMID: 38321598 DOI: 10.1097/ftd.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/22/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Volumetric Absorptive Microsampling (VAMS) is a useful tool for therapeutic drug monitoring (TDM) of oral targeted anticancer agents. VAMS aims to improve safety and efficacy by enabling at-home blood sample collection by patients. This study aimed to develop and validate an ultra-high performance liquid chromatography-tandem mass spectrometry method for the quantitative determination of abiraterone, alectinib, cabozantinib, imatinib, olaparib, sunitinib, and the metabolites, Δ(4)-abiraterone (D4A), alectinib-M4, imatinib-M1, and N -desethyl sunitinib, in dried whole blood samples using VAMS to support TDM. METHODS After the collection of 10 μL of whole blood sample using the VAMS device, the analytes were extracted from the tip using methanol with shaking, evaporated, and reconstituted in acetonitrile:0.1 mol/L ammonium hydroxide in water (1:1, vol/vol). The extracts were then analyzed using ultra-high performance liquid chromatography-tandem mass spectrometry. Validation experiments based on the ICH M10 guideline were carried out, and stability was evaluated under shipping and storage conditions. VAMS specimens were collected in the outpatient clinic to demonstrate the applicability of the assay. RESULTS The validated range of the method was considered accurate and precise for all analytes. Accordingly, the validation experiments met the relevant requirements, except for cross-analyte interference. Based on the stability data, shipment can be performed at room temperature within 14 days after sample collection and the VAMS specimen can be stored up to 9 months at -20 and -70°C. Samples from 59 patients were collected at the hospital. CONCLUSIONS The developed method could be used to successfully quantify the concentrations of abiraterone, D4A, alectinib, alectinib-M4, cabozantinib, imatinib, imatinib-M1, olaparib, sunitinib, and N -desethyl sunitinib within the validated range using VAMS. Therefore, the method can be used to estimate the dried whole blood-to-plasma ratios for TDM in the clinic.
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Affiliation(s)
- Marinda Meertens
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Niels de Vries
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Hilde Rosing
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands; and
- Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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10
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Zijp TR, Izzah Z, Touw DJ, van Boven JFM. Medication Adherence Monitoring Using Alternative Sample Matrices: Bridging the Gap Between Analytical Validation and Clinical Interpretation. Ther Drug Monit 2024; 46:554-555. [PMID: 38845090 PMCID: PMC11232933 DOI: 10.1097/ftd.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Affiliation(s)
- Tanja R Zijp
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Zamrotul Izzah
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia ; and
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, the Netherlands
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11
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Narayanan S, Yuile A, Venkatesh B, McKay M, Itchins M, Pavlakis N, Wheeler H, Gray L, Wei J, Miller S, Kirwin B, Molloy MP, Clarke S. Therapeutic drug monitoring of osimertinib in EGFR mutant non-small cell lung cancer by dried blood spot and plasma collection: A pilot study. Br J Clin Pharmacol 2024; 90:1942-1951. [PMID: 38706157 DOI: 10.1111/bcp.16070] [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: 10/30/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 05/07/2024] Open
Abstract
AIMS Therapeutic drug monitoring (TDM) has led to significant improvements in individualized medical care, although its implementation in oncology has been limited to date. Tyrosine kinase inhibitors (TKIs) are a group of therapies for which TDM has been suggested. Osimertinib is one such therapy used in the treatment of epidermal growth factor receptor (EGFR) mutation-driven lung cancer. Herein, we describe a prospective pilot study involving 21 patients on osimertinib primarily as a preliminary evaluation of drug levels in a real-world setting. METHODS Concentrations of the drug and its primary metabolites were measured with a validated liquid chromatography-mass spectrometry (LC-MS) assay across serial timepoints. As part of this study, inter-individual variability by dose and ethnicity as well as intra-individual variability across timepoints are explored. Furthermore, we attempted to validate dried blood spot (DBS)-based quantitation as an accurate alternative to plasma quantitation. RESULTS Successful quantitation of osimertinib and primary metabolites was achieved for our subjects. Compound plasma levels were highly correlated to DBS levels. There was no significant difference in concentrations with ethnicity or dosing or intra-individual variability across timepoints. CONCLUSIONS As such, we demonstrate that TDM for osimertinib is practical for future trials. We also validated the use of DBS as an alternative to conventional quantitation for exploration of TDM for osimertinib in larger trials and for other targeted therapies.
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Affiliation(s)
- Sathya Narayanan
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
- Macquarie University Clinical Trials Unit, Macquarie University, Sydney, NSW, Australia
| | - Alexander Yuile
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
- School of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Bharat Venkatesh
- Kolling Institute of Medical Research, Sydney, NSW, Australia
- School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Matthew McKay
- Kolling Institute of Medical Research, Sydney, NSW, Australia
- School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Malinda Itchins
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
- School of Medicine, University of Sydney, Sydney, NSW, Australia
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
- School of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Helen Wheeler
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
- School of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Lauren Gray
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Joe Wei
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Samuel Miller
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Brendan Kirwin
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Mark P Molloy
- Kolling Institute of Medical Research, Sydney, NSW, Australia
- School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Stephen Clarke
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
- School of Medicine, University of Sydney, Sydney, NSW, Australia
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12
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Li J, Ulloa GM, Mayor P, Santolalla Robles ML, Greenwood AD. Nucleic acid degradation after long-term dried blood spot storage. Mol Ecol Resour 2024; 24:e13979. [PMID: 38780145 DOI: 10.1111/1755-0998.13979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/16/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
Collecting and preserving biological samples in the field, particularly in remote areas in tropical forests, prior to laboratory analysis is challenging. Blood samples in many cases are used for nucleic acid-based species determination, genomics or pathogen research. In most cases, maintaining a cold chain is impossible and samples remain at ambient temperature for extended periods of time before controlled storage conditions become available. Dried blood spot (DBS) storage, blood stored on cellulose-based paper, has been widely applied to facilitate sample collection and preservation in the field for decades. However, it is unclear how long-term storage on this substrate affects nucleic acid concentration and integrity. We analysed nucleic acid quality from DBS stored on Whatman filter paper no. 3 and FTA cards for up to 15 years in comparison to cold-chain stored samples using four nucleic acid extraction methods. We examined the ability to identify viral sequences from samples of 12 free-ranging primates in the Amazon forest, using targeted hybridization capture, and determined if mitochondrial genomes could be retrieved. The results suggest that even after extended periods of storage, DBS will be suitable for some genomic applications but may be of limited use for viral pathogen research, particularly RNA viruses.
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Affiliation(s)
- Juan Li
- Department of Wildlife Diseases, Leibniz Institute for Zoo and Wildlife Research (IZW), Berlin, Germany
| | - Gabriela M Ulloa
- Programa de Pós-Graduação em Saúde e Produção Animal na Amazônia, Universidade Federal Rural da Amazônia (UFRA), Belém, Pará, Brazil
- Grupo de Enfermedades Infecciosas Re-emergentes, Universidad Científica del Sur (UCSUR), Lima, Peru
| | - Pedro Mayor
- Programa de Pós-Graduação em Saúde e Produção Animal na Amazônia, Universidade Federal Rural da Amazônia (UFRA), Belém, Pará, Brazil
- ComFauna, Comunidad de Manejo de Fauna Silvestre en la Amazonía y en Latinoamérica, Iquitos, Peru
- Departament de Sanitat i Anatomia Animals, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Meddly L Santolalla Robles
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alex D Greenwood
- Department of Wildlife Diseases, Leibniz Institute for Zoo and Wildlife Research (IZW), Berlin, Germany
- School of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
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13
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Versmissen J, van Steenkiste J, Koch BCP, Peeters LEJ. 'Under pressure': The role of therapeutic drug monitoring in the treatment of hypertension. Br J Clin Pharmacol 2024; 90:1884-1891. [PMID: 38845455 DOI: 10.1111/bcp.16125] [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: 02/01/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 07/31/2024] Open
Abstract
Antihypertensive drugs do not qualify as optimal candidates for therapeutic drug monitoring (TDM), given their obvious physiological effect, the absence of a clear relationship between drug concentrations and pharmacodynamic outcomes and their wide therapeutic range. However, since non-adherence is a major challenge in hypertension management, using drug concentrations can be of value to identify non-adherence as a first step towards better blood pressure control. In this article we discuss the key challenges associated with measuring and interpreting antihypertensive drug concentrations that are important when TDM is used to improve non-adherence. Additionally, we elaborate on the role of TDM in optimizing antihypertensive drug treatment besides addressing non-adherence by highlighting its value in specific patient groups with altered pharmacokinetic parameters such as female vs. male or elderly patients.
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Affiliation(s)
- Jorie Versmissen
- Department of Hospital Pharmacy, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Job van Steenkiste
- Department of Hospital Pharmacy, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Maasstad hospital, Department of Internal Medicine, Rotterdam, the Netherlands
- Department of Management Sciences, Open University Netherlands, Heerlen, the Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Laura E J Peeters
- Department of Hospital Pharmacy, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Maasstad hospital, Rotterdam, the Netherlands
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14
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Leino AD, Takyi-Williams J, Park JM, Norman SP, Sun D, Farris KB, Pai MP. Clinical validation of two volumetric absorptive microsampling devices to support home-based therapeutic drug monitoring of immunosuppression. Br J Clin Pharmacol 2024. [PMID: 39051148 DOI: 10.1111/bcp.16182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 07/27/2024] Open
Abstract
AIMS Dried blood volumetric absorptive microsamples (VAMS) may facilitate home-based sampling to enhance therapeutic drug monitoring after transplantation. This study aimed to clinically validate a liquid chromatography-tandem mass spectrometry assay using 2 VAMS devices with different sampling locations (Tasso-M20 for the upper arm and Mitra for the finger). Patient preferences were also evaluated. METHODS Clinical validation was performed for tacrolimus and mycophenolic acid by comparison of paired VAMS and venipuncture samples using Passing-Bablok regression and Bland-Altman analysis. Conversion of mycophenolic acid VAMS to serum concentrations was evaluated using haematocrit-dependent formulas and fixed correction factors defined a priori. Patients' perspectives, including useability, acceptability and feasibility, were also investigated using established questionnaires. RESULTS Paired samples (n = 50) were collected from 25 kidney transplant recipients. Differences for tacrolimus whole-blood concentration were within ±20% for 86 and 88% of samples from the upper arm and fingerstick, respectively. Using correction factors of 1.3 for the upper-arm and 1.47 for finger-prick samples, 84 and 76% of the paired samples, respectively, were within ±20% for mycophenolic acid serum concentration. Patient experience surveys demonstrated limited pain and acceptable useability of the upper-arm device. CONCLUSIONS Tacrolimus and mycophenolic acid can be measured using 2 common VAMS devices with similar analytical performance. Patients are supportive of home-based monitoring with a preference for the Tasso-M20 device.
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Affiliation(s)
- Abbie D Leino
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - John Takyi-Williams
- Pharmacokinetic & Mass Spectrometry Core, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Jeong M Park
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Silas P Norman
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Duxin Sun
- Pharmacokinetic & Mass Spectrometry Core, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Karen B Farris
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Manjunath P Pai
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
- Pharmacokinetic & Mass Spectrometry Core, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
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15
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Boffel L, Van Mensel A, Pauwels J, Den Hond E, Bessems J, Van Uytfanghe K, Stove CP. Self-Sampling by Adolescents at Home: Assessment of the Feasibility to Successfully Collect Blood Microsamples by Inexperienced Individuals. AAPS J 2024; 26:75. [PMID: 38955903 DOI: 10.1208/s12248-024-00947-1] [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: 03/28/2024] [Accepted: 06/13/2024] [Indexed: 07/04/2024] Open
Abstract
Blood microsampling has increasingly attracted interest in the past decades as a more patient-centric sampling approach, offering the possibility to collect a minimal volume of blood following a finger or arm prick at home. In addition to conventional dried blood spots (DBS), many different devices allowing self-sampling of blood have become available. Obviously, the success of home-sampling can only be assured when (inexperienced) users collect samples of good quality. Therefore, the feasibility of six different microsampling devices to collect capillary blood by inexperienced adolescents at home was evaluated. Participants (n = 95) were randomly assigned to collect blood (dried or liquid) at different time points using four of six different self-sampling devices (i.e., DBS, Mitra volumetric absorptive microsampling (VAMS), Capitainer B, Tasso M20, Minicollect tube and Tasso+ serum separator tube (SST)). The quality of the samples was visually inspected and analytically determined. Moreover, the participants' satisfaction was assessed via questionnaires. Although a majority succeeded based on the visual inspection, the success rate differed largely between the different devices. In general, the lowest success rate was obtained for the Minicollect tubes, although there is an opportunity and need for improvement for the other self-sampling devices as well. Hence, this also emphasizes the importance to assess the quality of samples collected by the target population prior to study initiation. In addition, visual classification by a trained individual was confirmed based on assessment of the analytical variability between replicates. Finally, self-sampling at home was overall (very) positively received by the participants.
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Affiliation(s)
- Laura Boffel
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ottergemsesteenweg 46, Ghent, B-9000, Belgium
| | | | - Janne Pauwels
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | | | - Jos Bessems
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Katleen Van Uytfanghe
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ottergemsesteenweg 46, Ghent, B-9000, Belgium
| | - Christophe P Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ottergemsesteenweg 46, Ghent, B-9000, Belgium.
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16
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Hazenbroek M, Pengel LHM, Sassen SDT, Massey EK, Reinders MEJ, de Winter BCM, Hesselink DA. Removing the physician from the equation: Patient-controlled, home-based therapeutic drug self-monitoring of tacrolimus. Br J Clin Pharmacol 2024. [PMID: 38830672 DOI: 10.1111/bcp.16121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 06/05/2024] Open
Abstract
The dosing of tacrolimus, which forms the backbone of immunosuppressive therapy after kidney transplantation, is complex. This is due to its variable pharmacokinetics (both between and within individual patients), narrow therapeutic index, and the severe consequences of over- and underexposure, which may cause toxicity and rejection, respectively. Tacrolimus is, therefore, routinely dosed by means of therapeutic drug monitoring (TDM). TDM is performed for as long as the transplant functions and frequent and often lifelong sampling is therefore the rule. This puts a significant burden on patients and transplant professionals and is associated with high healthcare-associated costs. Furthermore, by its very nature, TDM is reactive and has no predictive power. Finally, the current practice of TDM does not foresee in an active role for patients themselves. Rather, the physician or pharmacist prescribes the next tacrolimus dose after obtaining the concentration measurement test results. In this article, we propose a strategy of patient-controlled, home-based, self-TDM of the immunosuppressant tacrolimus after transplantation. We argue that with the combined use of population tacrolimus pharmacokinetic models, home-based sampling by means of dried blood spotting and implementation of telemedicine, this may become a feasible approach in the near future.
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Affiliation(s)
- Marinus Hazenbroek
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Liset H M Pengel
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sebastiaan D T Sassen
- Erasmus MC, Rotterdam Clinical Pharmacometrics Group, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Emma K Massey
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marlies E J Reinders
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Brenda C M de Winter
- Erasmus MC, Rotterdam Clinical Pharmacometrics Group, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dennis A Hesselink
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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17
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Venkatesh B, Yuile A, McKay MJ, Narayanan S, Wheeler H, Itchins M, Pavlakis N, Clarke SJ, Molloy MP. A Validated Assay to Quantify Osimertinib and Its Metabolites, AZ5104 and AZ7550, from Microsampled Dried Blood Spots and Plasma. Ther Drug Monit 2024; 46:332-343. [PMID: 38263583 PMCID: PMC11078286 DOI: 10.1097/ftd.0000000000001157] [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: 05/21/2023] [Accepted: 08/29/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Osimertinib is an oral small-molecule tyrosine kinase receptor inhibitor used to treat non-small cell lung cancer (NSCLC) with a sensitizing epidermal growth factor receptor mutation. Patients may experience drug toxicity and require dose deescalation. The study aimed to quantitate osimertinib and its 2 active metabolites, AZ5104 and AZ7550, in microsampled dried blood spots (DBS) collected from patients with NSCLC using a hemaPEN device and compare them with plasma drug levels. METHODS A 6-min ultrahigh-performance liquid chromatography-tandem mass spectrometry method was developed and validated using plasma and DBS. The accuracy, selectivity, matrix effect, recovery, and stability were assessed using bioanalytical validation criteria. The hematocrit effect was investigated in DBS. Drug levels were measured in 15 patients with NSCLC, and the Bland-Altman method was used to compare measurements between plasma and DBS. RESULTS The validated assay determined accurate and precise quantities, respectively, for osimertinib in both plasma (93.2%-99.3%; 0.2%-2.3%) and DBS (96.7%-99.6%; 0.5%-10.3%) over a concentration of 1-729 ng/mL. The osimertinib metabolites, AZ5104 and AZ7550, were similarly validated in accordance with bioanalytical guidelines. For 30%-60% patient hematocrit, no hematocrit bias was observed with DBS for all analytes. The Bland-Altman method showed high concordance between plasma and DBS analyte levels. Stability experiments revealed that osimertinib and its metabolites were poorly stable in plasma at room temperature, whereas all analytes were stable in DBS for 10 days at room temperature. CONCLUSIONS The measurement of osimertinib, AZ5104, and AZ7550 from hemaPEN microsampled DBS is a convenient and reliable approach for therapeutic drug monitoring that produces measurements consistent with plasma drug levels.
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Affiliation(s)
- Bharat Venkatesh
- Bowel Cancer and Biomarker Laboratory, School of Medical Sciences, Kolling Institute, The University of Sydney, Sydney, NSW, Australia; and
| | - Alex Yuile
- Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia
| | - Matthew J. McKay
- Bowel Cancer and Biomarker Laboratory, School of Medical Sciences, Kolling Institute, The University of Sydney, Sydney, NSW, Australia; and
| | - Sathya Narayanan
- Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia
| | - Helen Wheeler
- Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia
| | - Malinda Itchins
- Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia
| | - Stephen J. Clarke
- Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia
| | - Mark P. Molloy
- Bowel Cancer and Biomarker Laboratory, School of Medical Sciences, Kolling Institute, The University of Sydney, Sydney, NSW, Australia; and
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18
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Trontelj J, Rozman A, Mrhar A. Determination of remifentanil in neonatal dried blood spots by liquid chromatography-tandem mass spectrometry. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2024; 74:343-354. [PMID: 38815198 DOI: 10.2478/acph-2024-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 06/01/2024]
Abstract
Remifentanil is an ultra-short-acting synthetic opioid-class analgesic which might be increasingly used "off-label" as pain management during labour. Side effects in parturients during labour, and in the infant at birth are of particular concern, especially respiratory depression which is concentration-dependent, and can occur at levels as low as 3-5 ng mL-1. The safety of such use, particularly in newborns due to remifentanil placental transfer, has not been fully demonstrated yet, partly due to the lack of a suitable non-invasive analytical method. The aim of our work was to develop a sensitive method to monitor the levels of remifentanil in neonates by a non-invasive sampling of umbi lical cord blood to support efficacy and safety trials. The presented LC-MS method is sensitive enough to reliably quantify remifentanil in just 20 µL of blood at only 0.3 ng mL-1. The dried blood spot sample preparation included solvent extraction with subsequent solid-phase extraction. The method was validated in terms of accuracy, precision, recovery, matrix effect, and stability, and was successfully applied to a small pilot study. The estimated arterial blood concentrations at the time of delivery ranged from 0.2 to 0.3, and up to 0.9 ng mL-1 in neonatal, and maternal samples, respectively.
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Affiliation(s)
- Jurij Trontelj
- 1University of Ljubljana, Faculty of Pharmacy 1000 Ljubljana, Slovenia
| | - Aleš Rozman
- 2Gynecology and Obstetrics Hospital Kranj, 4000 Kranj Slovenia
| | - Aleš Mrhar
- 1University of Ljubljana, Faculty of Pharmacy 1000 Ljubljana, Slovenia
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19
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van der Meer R, Wilms EB, Eggermont MN, Paalvast HM, van Luin M, van Rossen RCJM, Heijerman HGM. Elexacaftor/tezacaftor/ivacaftor in liver or kidney transplanted people with cystic fibrosis using tacrolimus, a drug-drug interaction study. J Cyst Fibros 2024; 23:549-553. [PMID: 38290918 DOI: 10.1016/j.jcf.2024.01.008] [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: 09/01/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND The use of elexacaftor/tezacaftor/ivacaftor (ETI) in people with cystic fibrosis (pwCF) after solid organ transplantation is controversial because of potential drug-drug interactions (DDI) with tacrolimus. We aimed to improve insight into the safety and clinical benefits of co-administration of ETI and tacrolimus in liver or kidney transplanted adult pwCF. METHODS In 5 pwCF, tacrolimus concentrations were monitored during 2 weeks before and 4 weeks after starting ETI treatment. Trough levels, area under the curve (AUC) and clinical effect of ETI were investigated. During the study (6 weeks in total) adverse events were monitored. RESULTS The DDI between tacrolimus and ETI resulted in an increased exposure of tacrolimus in all subjects, the dose adjusted AUC0-24h was 1.79 (median) times higher at the end of the study. Five dose adjustments were performed in 4 subjects in order to attain tacrolimus target range. No adverse events were reported and all subjects showed clinical improvement during ETI treatment. CONCLUSION The clinical value of ETI treatment in kidney and liver transplanted pwCF is clear. The use of ETI may increase tacrolimus levels moderately. Therefore, we recommend close monitoring of tacrolimus trough levels in patients who start ETI.
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Affiliation(s)
- Renske van der Meer
- Department of Pulmonology and Adult CF Centre, Haga Hospital, Els Borst-Eilersplein 275, The Hague 2545 AA, The Netherlands.
| | - Erik B Wilms
- Central Hospital Pharmacy (Laboratory AHZ), Charlotte Jacobslaan 70, The Hague 2545 AB, The Netherlands
| | - Margot N Eggermont
- Department of Pulmonology and Adult CF Centre, Haga Hospital, Els Borst-Eilersplein 275, The Hague 2545 AA, The Netherlands
| | - Helena M Paalvast
- Department of Pulmonology and Adult CF Centre, Haga Hospital, Els Borst-Eilersplein 275, The Hague 2545 AA, The Netherlands
| | - Matthijs van Luin
- Department of Clinical Pharmacy, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Richard C J M van Rossen
- Central Hospital Pharmacy (Laboratory AHZ), Charlotte Jacobslaan 70, The Hague 2545 AB, The Netherlands
| | - Harry G M Heijerman
- Department of Pulmonology and Adult CF Centre, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
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20
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Geers LM, Loonen AJM, Touw DJ. Microsampling Techniques Suitable for Therapeutic Drug Monitoring of Antipsychotics. J Clin Psychopharmacol 2024; 44:302-310. [PMID: 38639427 DOI: 10.1097/jcp.0000000000001855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) of antipsychotics for dose titration or detection of noncompliance is not uncommon in daily practice. Normally, TDM implies measuring a drug concentration in venous blood samples. This technique is invasive and requires trained assistants and patients normally need to go to an outpatient clinic. Over the past decades, sensitivity of analytical equipment has improved leading to a growing interest in microsampling techniques. These techniques are minimally invasive, require a small volume (<100 μL), usually result in stable samples, and can be collected by the patient or a caregiver at home. Before a microsampling technique can be used in daily routine, proper method development and a clinical validation study should be performed. METHOD For this review, the databases of PubMed and Embase were systematically searched. Currently available microsampling techniques for antipsychotics in blood, serum, or plasma are summarized. Subsequently, it has also been assessed whether these techniques are sufficiently validated for TDM monitoring in daily practice. RESULTS Several microsampling techniques are available today, for example, dried blood spot sampling, dried plasma extraction cards, and volumetric absorptive microsampling. Eighteen studies were identified in which a microsampling technique for 1 or a few antipsychotics was chemically analytically and clinically validated. However, the majority of these studies have relevant shortcomings that mean its usefulness for different antipsychotics is not yet well established. CONCLUSIONS Microsampling for TDM can be recommended for patients using clozapine. For TDM of other antipsychotics, it is a very promising development.
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Affiliation(s)
| | - Anton J M Loonen
- University of Groningen, Groningen Research Institute of Pharmacy, Pharmacotherapy, -Epidemiology & -Economics
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21
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Jacobs CM, Radosa JC, Wagmann L, Zimmermann JSM, Kaya AC, Aygün A, Edel T, Stotz L, Ismaeil M, Solomayer EF, Meyer MR. Towards clinical adherence monitoring of oral endocrine breast cancer therapies by LC-HRMS-method development, validation, comparison of four sample matrices, and proof of concept. Anal Bioanal Chem 2024; 416:2969-2981. [PMID: 38488952 PMCID: PMC11045636 DOI: 10.1007/s00216-024-05244-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
Oral endocrine therapies (OET) for breast cancer treatment need to be taken over a long period of time and are associated with considerable side effects. Therefore, adherence to OET is an important issue and of high clinical significance for breast cancer patients' caregivers. We hypothesized that a new bioanalytical strategy based on liquid chromatography and high-resolution mass spectrometry might be suitable for unbiased adherence monitoring (AM) of OET. Four different biomatrices (plasma, urine, finger prick blood by volumetric absorptive microsampling (VAMS), oral fluid (OF)) were evaluated regarding their suitability for AM of the OET abemaciclib, anastrozole, exemestane, letrozole, palbociclib, ribociclib, tamoxifen, and endoxifen. An analytical method was developed and validated according to international recommendations. The analytical procedures were successfully validated in all sample matrices for most analytes, even meeting requirements for therapeutic drug monitoring. Chromatographic separation of analytes was achieved in less than 10 min and limits of quantification ranged from 1 to 1000 ng/mL. The analysis of 25 matching patient samples showed that AM of OET is possible using all four matrices with the exception of, e.g., letrozole and exemestane in OF. We were able to show that unbiased bioanalytical AM of OET was possible using different biomatrices with distinct restrictions. Sample collection of VAMS was difficult in most cases due to circulatory restraints and peripheral neuropathy in fingers and OF sampling was hampered by dry mouth syndrome in some cases. Although parent compounds could be detected in most of the urine samples, metabolites should be included when analyzing urine or OF. Plasma is currently the most suitable matrix due to available reference concentrations.
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Affiliation(s)
- Cathy M Jacobs
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University, Homburg, Germany
| | - Julia C Radosa
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
| | - Lea Wagmann
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University, Homburg, Germany
| | - Julia S M Zimmermann
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
| | - Askin C Kaya
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
| | - Aylin Aygün
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
| | - Tatjana Edel
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
| | - Lisa Stotz
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
| | - Mohamed Ismaeil
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
| | - Erich-Franz Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Saarland, Germany
| | - Markus R Meyer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University, Homburg, Germany.
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Ludna Duarte M, Mikaelle Brandão Silva A, Wellithom Viturino da Silva J, Pereira Santana D, Victor de Castro W, Cláudio Arraes de Alencar L, César Galindo Bedor D, Bastos Leal L. A validated method for simultaneous quantification of four antiretrovirals in dried blood spot and plasma using LC-MS/MS: Application to efavirenz therapeutic drug monitoring in pregnant patients. Clin Biochem 2024; 127-128:110765. [PMID: 38649089 DOI: 10.1016/j.clinbiochem.2024.110765] [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: 10/09/2023] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION The specific physiological background induced by pregnancy leads to significant changes in maternal pharmacokinetics, suggesting potential variability in plasma concentrations of antiretrovirals. Pregnant HIV patients exposed to subtherapeutic doses, particularly in the last trimester of the pregnancy, have higher chances to transmit the infection to their children. Therefore, the therapeutic drug monitoring of antiretrovirals in HIV pregnant patients would be of great value. OBJECTIVES This study aimed to develop and validate a sensitive liquid chromatograph tandem mass spectrometry (LC-MS/MS) method for simultaneous quantification of efavirenz, raltegravir, atazanavir, and ritonavir in dried blood spots (DBS) and plasma. DESIGN AND METHODS The analytes were extracted from the DBS punch and plasma with a mixture of methanol:zinc sulfate 200 mM (50:50, v/v) and 100 % methanol, respectively. For the chromatographic separation a Shim-pack® C18, 4.6 mm × 150 mm, 5 μm column was used. Detection was performed in a 3200-QTRAP® mass spectrometer, with a run time of 6 min. RESULTS The assay was linear in the range of 15-1,000 ng/mL for raltegravir, 50-10,000 ng/mL for both atazanavir and ritonavir, 50-5,000 ng/mL for efavirenz. Precision and accuracy at these concentrations were less than 15 % for all analytes. Raltegravir, atazanavir, and ritonavir were stable for seven days at 23 °C and 40 °C, whereas efavirenz was stable for twenty-four hours at the same conditions. CONCLUSIONS The method was successfully applied to quantify efavirenz in DBS samples obtained from HIV-1 infected pregnant volunteers under antiretroviral therapy. The concentrations of efavirenz in DBS and plasma were comparable according to Passing-Bablok regression and Bland-Altman analysis.
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Affiliation(s)
- Maira Ludna Duarte
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Campus Recife, S/n, Recife, Pernambuco, CEP 50740-521, Brazil.
| | - Aurylanne Mikaelle Brandão Silva
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Campus Recife, S/n, Recife, Pernambuco, CEP 50740-521, Brazil
| | - José Wellithom Viturino da Silva
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Campus Recife, S/n, Recife, Pernambuco, CEP 50740-521, Brazil
| | - Davi Pereira Santana
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Campus Recife, S/n, Recife, Pernambuco, CEP 50740-521, Brazil.
| | - Whocely Victor de Castro
- Graduate Program in Pharmaceutical Sciences, Federal University of São João del-Rei, Av. Sebastião Gonçalves Coelho 400, Chanadour, Divinópolis, Minas Gerais, CEP 35501-296, Brazil.
| | - Luiz Cláudio Arraes de Alencar
- Department of Tropical Medicine, Federal University of Pernambuco, Campus Recife, S/n, Recife, Pernambuco, CEP 50740-521, Brazil
| | - Danilo César Galindo Bedor
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Campus Recife, S/n, Recife, Pernambuco, CEP 50740-521, Brazil.
| | - Leila Bastos Leal
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Campus Recife, S/n, Recife, Pernambuco, CEP 50740-521, Brazil.
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Scherf-Clavel M, Baumann P, Hart XM, Schneider H, Schoretsanitis G, Steimer W, Zernig G, Zurek G. Behind the Curtain: Therapeutic Drug Monitoring of Psychotropic Drugs from a Laboratory Analytical Perspective. Ther Drug Monit 2024; 46:143-154. [PMID: 36941240 DOI: 10.1097/ftd.0000000000001092] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE Therapeutic drug monitoring (TDM) is a well-established tool for guiding psychopharmacotherapy and improving patient care. Despite their established roles in the prescription of psychotropic drugs, the "behind the curtain" processes of TDM requests are invariably obscure to clinicians, and literature addressing this topic is scarce. METHODS In the present narrative review, we provide a comprehensive overview of the various steps, starting from requesting TDM to interpreting TDM findings, in routine clinical practice. Our goal was to improve clinicians' insights into the numerous factors that may explain the variations in TDM findings due to methodological issues. RESULTS We discussed challenges throughout the TDM process, starting from the analyte and its major variation forms, through sampling procedures and pre-analytical conditions, time of blood sampling, sample matrices, and collection tubes, to analytical methods, their advantages and shortcomings, and the applied quality procedures. Additionally, we critically reviewed the current and future advances in the TDM of psychotropic drugs. CONCLUSIONS The "behind the curtain" processes enabling TDM involve a multidisciplinary team, which faces numerous challenges in clinical routine. A better understanding of these processes will allow clinicians to join the efforts for achieving higher-quality TDM findings, which will in turn improve treatment effectiveness and safety outcomes of psychotropic agents.
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Affiliation(s)
- Maike Scherf-Clavel
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
| | - Pierre Baumann
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn, Germany
| | - Xenia M Hart
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Heike Schneider
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich, Munich, Germany
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn
- INSTAND e.V. Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn, Germany
| | - Georgios Schoretsanitis
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Werner Steimer
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich, Munich, Germany
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn
| | - Gerald Zernig
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
- Private Practice for Psychotherapy and Court-certified Expert Witness, Hall in Tirol, Austria; and
| | - Gabriela Zurek
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Medical Laboratory Bremen, Bremen, Germany
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24
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Davies Forsman L, Kim HY, Nguyen TA, Alffenaar JWC. Salivary Therapeutic Drug Monitoring of Antimicrobial Therapy: Feasible or Futile? Clin Pharmacokinet 2024; 63:269-278. [PMID: 38300489 PMCID: PMC10954910 DOI: 10.1007/s40262-024-01346-7] [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] [Accepted: 01/07/2024] [Indexed: 02/02/2024]
Abstract
Personalised drug dosing through therapeutic drug monitoring (TDM) is important to maximise efficacy and to minimise toxicity. Hurdles preventing broad implementation of TDM in routine care include the need of sophisticated equipment and highly trained staff, high costs and lack of timely results. Salivary TDM is a non-invasive, patient-friendly alternative to blood sampling, which has the potential to overcome barriers with traditional TDM. A mobile UV spectrophotometer may provide a simple solution for analysing drug concentrations in saliva samples. Salivary TDM utilising point-of-care tests can support personalised dosing in various settings including low-resource as well as remote settings. In this opinion paper, we describe how hurdles of implementing traditional TDM may be mitigated by salivary TDM with new strategies for patient-friendly point-of-care testing.
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Affiliation(s)
- Lina Davies Forsman
- Division of Infectious Diseases, Department of Medicine, Karolinska Institute, Solna, Sweden
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Building A15, Science Road, Sydney, NSW, 2006, Australia
- Westmead Hospital, Sydney, Australia
| | - Hannah Yejin Kim
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Building A15, Science Road, Sydney, NSW, 2006, Australia
- The University of Sydney Infectious Diseases Institute (Sydney ID), Sydney, Australia
- Westmead Hospital, Sydney, Australia
| | - Thi Anh Nguyen
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Building A15, Science Road, Sydney, NSW, 2006, Australia
- The University of Sydney Infectious Diseases Institute (Sydney ID), Sydney, Australia
- Westmead Hospital, Sydney, Australia
| | - Jan-Willem C Alffenaar
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Building A15, Science Road, Sydney, NSW, 2006, Australia.
- The University of Sydney Infectious Diseases Institute (Sydney ID), Sydney, Australia.
- Westmead Hospital, Sydney, Australia.
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25
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Jacobs CM, Wagmann L, Meyer MR. Sample Matrices for Mass Spectrometry-Based Adherence Monitoring: A Systematic Critical Review. Ther Drug Monit 2024; 46:6-15. [PMID: 37798828 DOI: 10.1097/ftd.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/12/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Analytical monitoring of adherence using mass spectrometry (MS) plays an important role in clinical toxicology. Unambiguous detection of drugs (of abuse) and/or their metabolites in body fluids is needed to monitor intake of medication as prescribed or to monitor abstinence as a follow-up to detoxification procedures. This study focused on the advantages and disadvantages of different sample matrices used for MS-based adherence monitoring. METHODS Relevant articles were identified through a literature search in the PubMed database. English articles published between January 01, 2017, and December 31, 2022, were selected using the keywords "adherence assess*" or "adherence monit*" or "compliance assess*" or "compliance monit*" in combination with "mass spectrom*" in the title or abstract. RESULTS A total of 51 articles were identified, 37 of which were within the scope of this study. MS-based monitoring was shown to improve patient adherence to prescribed drugs. However, MS analysis may not be able to assess whether treatment was rigorously followed beyond the last few days before the sampling event, except when hair is the sample matrix. For medication adherence monitoring, blood-based analyses may be preferred because reference plasma concentrations are usually available, whereas for abstinence control, urine and hair samples have the advantage of extended detection windows compared with blood. Alternative sample matrices, such as dried blood samples, oral fluid, and exhaled breath, are suitable for at-home sampling; however, little information is available regarding the pharmacokinetics and reference ranges of drug (of abuse) concentrations. CONCLUSIONS Each sample matrix has strengths and weaknesses, and no single sample matrix can be considered the gold standard for monitoring adherence. It is important to have sufficient information regarding the pharmacokinetics of target substances to select a sample matrix in accordance with the desired purpose.
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Affiliation(s)
- Cathy M Jacobs
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University, Homburg, Germany
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26
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Heughebaert L, Stove CP. Is the stability of folates in dried blood microsamples sufficient to perform home-sampling studies? Analyst 2024; 149:895-908. [PMID: 38189100 DOI: 10.1039/d3an01004j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Dried blood microsampling is increasingly used for home-sampling and epidemiological studies because of its multiple advantages, including an often greatly improved analyte stability. However, a critical assessment of the stability under realistic conditions should always be performed as part of the validation, especially for unstable molecules like folates (vitamin B9). Here, the objective was to determine whether folate stability in dried blood microsamples is sufficient to allow the set-up of home-sampling studies for the monitoring of folate status in e.g., women of reproductive age. An extensive set of stability experiments was performed to evaluate the stability of the main folate vitamer 5-methyltetrahydrofolate (5MTHF), its oxidation product MeFOX and the minor non-methyl folate vitamers 10-formylfolic acid (10FoFA), 5,10-methenyltetrahydrofolate (5,10CH+THF) and tetrahydrofolate (THF) in dried blood microsamples using volumetric absorptive microsampling (VAMS) or regular dried blood spots (DBS). The evaluations included (EDTA-anticoagulated blood was collected from a single donor measured in four replicates per condition and time point): (i) the effect of temperature (-20 °C, 4 °C, ambient temperature and 37 °C), (ii) the effect of light (during drying and storage) and humidity, and (iii) the effect of storage under vacuum and pretreatment of the microsamples with stabilizing agents on folate stability. At -20 °C and 4 °C, all folate levels were within 85 to 115% of the baseline value up till two weeks of storage in both VAMS samples and DBS. However, at room temperature the stability of the analyzed folates was only consistently observed up till three days in VAMS samples, and for none of the folates at 37 °C. Humidity had a major impact on 5,10CH+THF stability, but this could be easily improved by using desiccant. Both vacuum treatment and pretreatment of microsamples with 0.1% DL-dithiothreitol and 5% butylated hydroxytoluene improved the stability at room temperature in VAMS samples, but these effects were limited at 37 °C and in DBS. Overall, the stability of the individual folate vitamers proved to be challenging and strongly temperature- and time-dependent. Nonetheless, if controlled transport (temperature and duration) can be assured, the set-up of home-sampling studies to evaluate the folate status using dried blood microsamples can still be beneficial.
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Affiliation(s)
- Liesl Heughebaert
- Laboratory of Toxicology, Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Christophe Pol Stove
- Laboratory of Toxicology, Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
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27
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Verougstraete N, Stove V, Stove CP. Remote HbA 1c testing via microsampling: fit for purpose? Clin Chem Lab Med 2024; 62:3-17. [PMID: 37419657 DOI: 10.1515/cclm-2023-0228] [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: 03/02/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023]
Abstract
The collection of capillary blood microsamples via finger-prick has several advantages over traditional blood collection. It is considered convenient and more patient-centric, enabling collection of the sample by the patient at her/his home with subsequent analysis in the lab following postal shipment. Determination of the diabetes biomarker HbA1c in self-collected microsamples to remotely monitor diabetes patients seems to be a very promising option which could eventually lead to better treatment adaptations and disease control. This is especially convenient/relevant for patients living in areas where venipuncture is impractical, or to support virtual consultations using telemedicine. Over the years, a substantial numbers of reports on HbA1c and microsampling have been published. However, the heterogeneity of the applied study designs and data evaluation is remarkable. This review provides a general and critical overview of these papers, along with specific points of attention that should be dealt with when aiming at implementing microsampling for reliable HbA1c determination. We focus on the used (dried) blood microsampling techniques, collection conditions, stability of the microsamples, sample extraction, analytical methods, method validation, correlation studies with conventional venous blood samples and patient satisfaction. Lastly, the possibility of using liquid instead of dried blood microsamples is discussed. Liquid blood microsampling is expected to have similar advantages as dried blood microsampling and several studies suggest it to be a suitable approach to collect samples remotely for subsequent HbA1c analysis in the lab.
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Affiliation(s)
- Nick Verougstraete
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Veronique Stove
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Christophe P Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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28
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Bahmany S, Hassanzai M, Flint RB, van Onzenoort HAW, de Winter BCM, Koch BCP. Dried blood spot analysis for the quantification of vancomycin and creatinine using liquid chromatography - tandem mass spectrometry: Method development and validation. Clin Chim Acta 2024; 553:117689. [PMID: 38052384 DOI: 10.1016/j.cca.2023.117689] [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: 07/14/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Vancomycin is a widely used antibiotic for the treatment of gram-positive bacterial infections, especially for methicillin-resistant Staphylococcus aureus (MRSA) infections. Due to a small therapeutic range and large inter-patient variability, therapeutic drug monitoring (TDM) of vancomycin is required to minimize toxicity and maximize treatment efficacy. Venous blood sampling is mostly applied for TDM of vancomycin, although this widely used sampling method is more invasive compared to less painful alternatives, such as the dried blood spot (DBS) method, which can be performed at home. METHOD We developed an UPLC-MS/MS method for the quantification of vancomycin and creatinine in DBS. A fast sample preparation and short analysis run time of 5.2 min were applied, which makes this method highly suitable for clinical settings. Validation was performed according to international (FDA and EMA) guidelines. RESULTS The validated concentration range was found linear for creatinine from 41.8 µmol/L to 722 µmol/L and for vancomycin from 3.8 mg/L to 76.6 mg/L (r2 > 0.990) and the inaccuracies, imprecisions, hematocrit effects, and recoveries were < 15 % for both compounds. No significant carryover effect was observed. CONCLUSION Hence, we successfully validated a quantification method for the simultaneous determination of creatinine and vancomycin in DBS.
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Affiliation(s)
- Soma Bahmany
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Moska Hassanzai
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Robert B Flint
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Pediatric and Neonatal Intensive Care, Division of Neonatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hein A W van Onzenoort
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Brenda C M de Winter
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands; CATOR: Center for Antimicrobial Treatment Optimization Rotterdam, the Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands; CATOR: Center for Antimicrobial Treatment Optimization Rotterdam, the Netherlands
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29
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Mukai Y, Doki K, Suzuki Y, Homma M. Utilizing the dry spot method to monitor the concentrations of biologic agents in breast milk. Br J Clin Pharmacol 2024; 90:368-369. [PMID: 37875351 DOI: 10.1111/bcp.15929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023] Open
Affiliation(s)
- Yuji Mukai
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Kosuke Doki
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Pharmaceutical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Yoshiharu Suzuki
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Masato Homma
- Department of Pharmacy, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Pharmaceutical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
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30
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Radovanovic M, Galettis P, Flynn A, Martin JH, Schneider JJ. Paclitaxel and Therapeutic Drug Monitoring with Microsampling in Clinical Practice. Pharmaceuticals (Basel) 2023; 17:63. [PMID: 38256896 PMCID: PMC10820540 DOI: 10.3390/ph17010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Paclitaxel is an anticancer agent efficacious in various tumors. There is large interindividual variability in drug plasma concentrations resulting in a wide variability in observed toxicity in patients. Studies have shown the time the concentration of paclitaxel exceeds 0.05 µM is a predictive parameter of toxicity, making dose individualization potentially useful in reducing the adverse effects. To determine paclitaxel drug concentration, a venous blood sample collected 24 h following the end of infusion is required, often inconvenient for patients. Alternatively, using a microsampling device for self-sampling would facilitate paclitaxel monitoring regardless of the patient's location. We investigated the feasibility of collecting venous and capillary samples (using a Mitra® device) from cancer patients to determine the paclitaxel concentrations. The relationship between the venous plasma and whole blood and venous and capillary blood (on Mitra®) paclitaxel concentrations, defined by a Passing-Bablok regression, were 0.8433 and 0.8569, respectively. Demonstrating a clinically acceptable relationship between plasma and whole blood paclitaxel concentration would reduce the need to establish new target concentrations in whole blood. However, in this study, comparison of venous and capillary blood using Mitra® for sampling displayed wide confidence intervals suggesting the results from the plasma and whole blood on this device may not be interchangeable.
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Affiliation(s)
- Mirjana Radovanovic
- Centre for Drug Repurposing and Medicines Research, University of Newcastle, Callaghan, NSW 2308, Australia; (P.G.); (A.F.); (J.H.M.); (J.J.S.)
- Drug Repurposing and Medicines Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Peter Galettis
- Centre for Drug Repurposing and Medicines Research, University of Newcastle, Callaghan, NSW 2308, Australia; (P.G.); (A.F.); (J.H.M.); (J.J.S.)
- Drug Repurposing and Medicines Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Alex Flynn
- Centre for Drug Repurposing and Medicines Research, University of Newcastle, Callaghan, NSW 2308, Australia; (P.G.); (A.F.); (J.H.M.); (J.J.S.)
- Drug Repurposing and Medicines Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Jennifer H. Martin
- Centre for Drug Repurposing and Medicines Research, University of Newcastle, Callaghan, NSW 2308, Australia; (P.G.); (A.F.); (J.H.M.); (J.J.S.)
- Drug Repurposing and Medicines Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Jennifer J. Schneider
- Centre for Drug Repurposing and Medicines Research, University of Newcastle, Callaghan, NSW 2308, Australia; (P.G.); (A.F.); (J.H.M.); (J.J.S.)
- Drug Repurposing and Medicines Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
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Vethe NT, Åsberg A, Andersen AM, Heier Skauby R, Bergan S, Midtvedt K. Clinical performance of volumetric finger-prick sampling for the monitoring of tacrolimus, creatinine and haemoglobin in kidney transplant recipients. Br J Clin Pharmacol 2023; 89:3690-3701. [PMID: 37537150 DOI: 10.1111/bcp.15870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/07/2023] [Accepted: 07/23/2023] [Indexed: 08/05/2023] Open
Abstract
AIMS Finger-prick sampling has emerged as an attractive tool for therapeutic drug monitoring and associated diagnostics. We aimed to validate the clinical performance of using two volumetric devices (Capitainer® qDBS and Mitra®) for monitoring tacrolimus, creatinine and haemoglobin in kidney transplant (KTx) recipients. Secondarily, we evaluated potential differences between finger-prick sampling performed by healthcare professionals vs. self-sampling, and differences between the two devices. METHODS We compared finger-prick and venous sampling in three settings: microsampling performed by healthcare personnel, self-sampling under supervision, unsupervised self-sampling. The finger-prick samples were analysed with adapted methods and results compared to routine method analysis of the venous blood samples. RESULTS Twenty-five KTx recipients completed the main study and 12 KTx recipients completed a post hoc validation study. For tacrolimus measurements and predicted area under the curve, the proportions within ±20% difference were 79%-96% for Capitainer and 77%-95% for Mitra. For creatinine and haemoglobin, the proportions within ±15% were 92%-100% and 93%-100% for Capitainer and 79%-96% and 67%-92% for Mitra, respectively. Comparing sampling situations, the success rate was consistent for Capitainer (92%-96%), whereas Mitra showed 72%-88% and 52%-72% success rates with samples collected by healthcare personnel and the patients themselves. CONCLUSIONS Capitainer and Mitra are technically feasible for measuring tacrolimus, creatinine and haemoglobin. In the context of self-sampling, Capitainer maintained consistent sampling success and analytical quality. Implementing volumetric finger-prick self-sampling for the monitoring of tacrolimus, creatinine and haemoglobin may simplify and improve the follow-up of KTx recipients.
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Affiliation(s)
- Nils Tore Vethe
- Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
| | | | | | - Stein Bergan
- Department of Pharmacology, Oslo University Hospital, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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Wang HB, Xiao X, Dai W, Peng R, Le J, Feng YQ, Wang ST. Rapid LC-MS/MS detection of 25-hydroxyvitamin D in dried blood spots. Anal Chim Acta 2023; 1283:341964. [PMID: 37977788 DOI: 10.1016/j.aca.2023.341964] [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: 07/11/2023] [Revised: 09/19/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The detection of 25-hydroxyvitamin D (25OHD) from dried blood spots (DBS) has been widely studied. However, the existing pretreatment methods suffer from limitations in terms of throughput (usually exceeding 2 h), complexity (involving liquid-liquid extraction or solid-phase extraction), and contamination (including multiple steps of organic solvent evaporation). RESULTS We first released 25OHD from DBS samples by 50% acetonitrile solution through ultrasonication. Subsequently, the cold-induced phase separation technique was introduced for in-situ concentration and purification. Afterward, the PTAD derivatization of 25OHD was performed directly, profiting from the high acetonitrile content in the concentrated solution. In the end, the resulting solution was submitted to LC-MS/MS for quantification. The established LC-MS/MS methodology possessed favorable analytical performance, possessing lower limit of quantification of 1 ng/mL pointing to plasma, accuracy of 86.8-110.1% and imprecision of 5.4-16.8%. Method comparison with plasma samples demonstrated that over 93% of the detections met the acceptance limit for cross-validation of ±20%. SIGNIFICANCE AND NOVELTY The novel sample preparation can be finished within 15 min and eliminated the traditional steps of extraction and organic solvent evaporation. Based on this high-throughput, reliable and applicable LC-MS/MS method, the detection of 25OHD in DBS samples can be better achieved for clinical patients and researchers with relevant demands.
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Affiliation(s)
- Hai-Bo Wang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, China.
| | - Xuan Xiao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, China.
| | - Wen Dai
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, China.
| | - Rui Peng
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, China.
| | - Juan Le
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, China.
| | - Yu-Qi Feng
- School of Public Health, Wuhan University, Wuhan, 430060, China.
| | - Shao-Ting Wang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, China.
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Millán-Santiago J, Vitagliano R, Mondella F, Mandrioli R, Sardella R, Vovk T, Lucena R, Cárdenas S, Boaron F, Serretti A, Petio C, Protti M, Mercolini L. Volumetric absorptive microsampling for the therapeutic drug monitoring of psychiatric patients treated with cariprazine. J Pharm Biomed Anal 2023; 236:115740. [PMID: 37776628 DOI: 10.1016/j.jpba.2023.115740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
Psychiatric disorders are usually treated with antipsychotic agents belonging to different pharmacological and chemical classes, the most recent ones collectively known as "third-generation antipsychotics", such as cariprazine, approved in 2015 for the treatment of patients affected by schizophrenia. For these patients, a frequent therapeutic drug monitoring (TDM) becomes essential to assess compliance and to optimise and personalise their therapy, also due to cariprazine interindividual variability and narrow therapeutic range. In this study, a bioanalytical method featuring miniaturised sampling and pretreatment was developed, based on volumetric absorptive microsampling (VAMS) for TDM of psychiatric patients under cariprazine treatment and compared to a reference method based on fluid plasma analysis. Minimally invasive whole blood VAMS was coupled to an original instrumental method based on ultra-high performance liquid chromatography hyphenated to mass spectrometry (UHPLC-MS). A feasible and streamlined, yet reliable VAMS pretreatment protocol was carefully optimised and the VAMS-UHPLC-MS methodology was validated with satisfactory results in terms of linearity (r2 > 0.9970 in the 1.5-100 ng/mL range), precision (%RSD < 11.7), extraction yield (> 90.0 %) and matrix effect (8.2 ≤ %RE ≤ 10.9). Finally, the microsampling approach coupled to UHPLC-MS was successfully applied to the TDM of psychiatric patients treated with cariprazine and compared with standard fluid plasma analysis, providing reliable quali-quantitative results, and proving to be readily applicable to the clinical practice in TDM programs as a useful alternative to cariprazine plasma analysis. This is the first report of a successful microsampling application, and in particular the first report of VAMS application, for the TDM of cariprazine.
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Affiliation(s)
- Jaime Millán-Santiago
- Research Group of Pharmaco-Toxicological Analysis (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy; Affordable and Sustainable Sample Preparation (AS2P) Research Group, Departamento de Química Analítica, Instituto Químico para la Energía y el Medioambiente (IQUEMA), Universidad de Córdoba, Campus de Rabanales, Edificio Marie Curie, E-14071 Córdoba, Spain
| | - Rosalba Vitagliano
- Research Group of Pharmaco-Toxicological Analysis (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy
| | - Fortunata Mondella
- Research Group of Pharmaco-Toxicological Analysis (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy
| | - Roberto Mandrioli
- Department for Life Quality Studies, Alma Mater Studiorum - University of Bologna, Corso d'Augusto 237, 47921 Rimini, Italy
| | - Roccaldo Sardella
- Department of Pharmaceutical Sciences, University of Perugia, Via Fabretti 48, 06123 Perugia, Italy
| | - Tomaž Vovk
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva 7, 1000 Ljubljana, Slovenia
| | - Rafael Lucena
- Affordable and Sustainable Sample Preparation (AS2P) Research Group, Departamento de Química Analítica, Instituto Químico para la Energía y el Medioambiente (IQUEMA), Universidad de Córdoba, Campus de Rabanales, Edificio Marie Curie, E-14071 Córdoba, Spain
| | - Soledad Cárdenas
- Affordable and Sustainable Sample Preparation (AS2P) Research Group, Departamento de Química Analítica, Instituto Químico para la Energía y el Medioambiente (IQUEMA), Universidad de Córdoba, Campus de Rabanales, Edificio Marie Curie, E-14071 Córdoba, Spain
| | - Federico Boaron
- Forensic Psychiatry Unit, Department of Mental Health and Substance Abuse, AUSL of Bologna, Via Terracini 31, 40131 Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Viale C. Pepoli 5, 40123 Bologna, Italy
| | - Carmine Petio
- Psychiatric Diagnosis and Treatment Service, AUSL of Bologna, S. Orsola - Malpighi University Hospital, Via Giuseppe Massarenti 9, 40138 Bologna, Italy
| | - Michele Protti
- Research Group of Pharmaco-Toxicological Analysis (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy.
| | - Laura Mercolini
- Research Group of Pharmaco-Toxicological Analysis (PTA Lab), Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy
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da Silva LC, Grando AP, de Baco LS, Hahn RZ, Ferreira Filho AF, Brucker N, Linden R, Antunes MV. Evaluation of dried blood spots as an alternative sampling strategy for 5-fluorouracil monitoring: From method development to clinical application. J Pharm Biomed Anal 2023; 235:115539. [PMID: 37517245 DOI: 10.1016/j.jpba.2023.115539] [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: 03/25/2023] [Revised: 06/01/2023] [Accepted: 06/18/2023] [Indexed: 08/01/2023]
Abstract
Therapeutic drug monitoring (TDM) of 5-Fluorouracil (5-FU) is strongly recommended because of its large inter-individual pharmacokinetic variability, narrow therapeutic window, and incidence of toxicity. However, there are several factors that limit the application of TDM in clinical settings. Considering the intrinsic advantages of dried microsamples, such as minimally invasive sampling, analyte stability, and cost-effective logistics, this study aimed to develop a method for the determination of 5-FU in dried blood spots (DBS) using ultra-high liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) and to evaluate its clinical application. Sample preparation was based on an aqueous extraction followed by protein precipitation. Separation was performed in an Acquity UPLC® HSS C18 (150 ×2.1 mm, 1.8 µm), and the mobile phases were water and acetonitrile with 0.5% acetic acid. The total run time was 5.5 min. The method was linear from 100 to 2000 ng/mL, precise (maximum CV% of 7.5%), and accurate (98.3-115.4%). The average recovery was 70%. Blood hematocrit had a minimal impact on the assay. DBS samples were stable for 21 days at 4, 25, and 45 °C. A total of 40 paired samples of plasma, capillary DBS, and venous DBS were analyzed. Median 5-FU concentrations were 444.7, 637.0, and 499.7 ng/mL for plasma, capillary DBS, and venous DBS, respectively. Capillary and plasma concentrations were significantly correlated (r > 0.90), but there was a lack of agreement between the methods, as capillary DBS levels were on average 146% of plasma. Venous DBS corresponded to 110% of the measured plasma concentrations, with a strong correlation (r > 0.97) and agreement between the methods. Our study is the first to report the use of DBS samples to quantify 5-FU. Further studies are needed to establish whether capillary samples can replace plasma.
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Affiliation(s)
- Laura C da Silva
- Graduate Program on Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil; Toxicological Analysis Laboratory, Institute of Health Sciences, Feevale University, Novo Hamburgo, RS, Brazil.
| | - Ana P Grando
- Toxicological Analysis Laboratory, Institute of Health Sciences, Feevale University, Novo Hamburgo, RS, Brazil
| | | | - Roberta Z Hahn
- Toxicological Analysis Laboratory, Institute of Health Sciences, Feevale University, Novo Hamburgo, RS, Brazil
| | | | | | - Rafael Linden
- Graduate Program on Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil; Toxicological Analysis Laboratory, Institute of Health Sciences, Feevale University, Novo Hamburgo, RS, Brazil
| | - Marina V Antunes
- Graduate Program on Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, RS, Brazil; Toxicological Analysis Laboratory, Institute of Health Sciences, Feevale University, Novo Hamburgo, RS, Brazil
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Qu S, Tao H, Qin L, Zhang W, Han S, Zhang S, Huang J. Harmonization of distributed multi-center analysis based on dried blood spot reference materials supporting the screening of neonatal inherited metabolic disorders. J Clin Lab Anal 2023; 37:e24970. [PMID: 37837220 PMCID: PMC10681404 DOI: 10.1002/jcla.24970] [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: 04/19/2023] [Revised: 07/07/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The standardization of quantification data is critical for ensuring the reliability and measurement traceability in the screening of neonatal inherited metabolic disorders. However, the availability of national certified reference materials is limited in China. METHODS In this study, we developed a series of dried blood spot (DBS) reference materials containing 9 amino acids (AA) and 10 acylcarnitines (AC) for neonatal screening. Four levels of the reference materials were measured with tandem mass spectrometry (MS/MS) by seven laboratories using different commercial In Vitro Diagnostic Device (IVD) kits. Then, 100 clinical samples were measured using both derivatization and non-derivatization methods by the same laboratory. RESULTS We found high homogeneity and stability at all levels of the reference materials, with the coefficient of variation (CV) of the analytes less than 15%. These reference materials can be used to assess the testing capabilities of different laboratories. Our test also revealed that the correction factors (CF) calculated by the reference materials, along with clinical samples, could increase the consistency for different kits. CONCLUSION The DBS reference materials proposed in this study provide reliability for the harmonization in multi-center analysis for the screening of neonatal inherited metabolic disorders. And applying our correction method for the screening could improve the data consistency of the DBS samples prepared by different methods.
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Affiliation(s)
- Shou‐Fang Qu
- Division of Diagnostic for Non‐infectious DiseaseNational Institutes for food and drug Control (NIFDC), Institute for in Vitro Diagnostic ControlBeijingChina
| | - Hao‐Ran Tao
- BGI GenomicsShenzhenChina
- College of Life Sciences, University of Chinese Academy of SciencesBeijingChina
| | | | - Wen‐Xin Zhang
- Division of Diagnostic for Non‐infectious DiseaseNational Institutes for food and drug Control (NIFDC), Institute for in Vitro Diagnostic ControlBeijingChina
| | - Shan Han
- GBI Biotech, BGI GenomicsBeijingChina
| | - Shen‐Yan Zhang
- BGI GenomicsShenzhenChina
- GBI Biotech, BGI GenomicsBeijingChina
| | - Jie Huang
- Division of Diagnostic for Non‐infectious DiseaseNational Institutes for food and drug Control (NIFDC), Institute for in Vitro Diagnostic ControlBeijingChina
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Prakasham K, Gurrani S, Wu CF, Wu MT, Hsieh TJ, Peng CY, Huang PC, Krishnan A, Tsai PC, Lin YC, Tsai B, Lin YC, Ponnusamy VK. Rapid identification and monitoring of cooking oil fume-based toxic volatile organic aldehydes in lung tissue for predicting exposure level and cancer risks. CHEMOSPHERE 2023; 339:139704. [PMID: 37536542 DOI: 10.1016/j.chemosphere.2023.139704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/08/2023] [Accepted: 07/30/2023] [Indexed: 08/05/2023]
Abstract
Cooking oil fumes (COFs) comprised of a mixture of cancer-causing volatile organic aldehydes (VOAs), particularly trans, trans-2,4-decadienal (t,t-DDE), 4-hydroxy-hexenal (4-HHE), and 4-hydroxy-nonenal (4-HNE). Monitoring toxic VOAs levels in people exposed to different cooking conditions is vital to predicting the cancer risk. For this purpose, we developed a fast tissue extraction (FaTEx) technique combined with UHPLC-MS/MS to monitor three toxic VOAs in mice lung tissue samples. FaTEx pre-treatment protocol was developed by combining two syringes for extraction and clean-up process. The various procedural steps affecting the FaTEx sample pre-treatment process were optimized to enhance the target VOAs' extraction efficiency from the sample matrix. Under the optimal experimental conditions, results exhibit good correlation coefficient values > 0.99, detection limits were between 0.5-3 ng/g, quantification limits were between 1-10 ng/g, and the matrix effect was <18.1%. Furthermore, the extraction recovery values of the spiked tissue exhibited between 88.9-109.6% with <8.6% of RSD. Cooking oil fume (containing t,t-DDE) treated mice at various time durations were sacrificed to validate the developed technique, and it was found that t,t-DDE concentrations were from 14.8 to 33.8 μg/g. The obtained results were found to be a fast, reliable, and semi-automated sample pre-treatment technique with good extraction efficiency, trace level detection limit, and less matrix effect. Therefore, this method can be applied as a potential analytical method to determine the VOAs in humans exposed to long-term cooking oil fumes.
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Affiliation(s)
- Karthikeyan Prakasham
- PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan; Research Center for Precision Environmental Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan
| | - Swapnil Gurrani
- PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan; Research Center for Precision Environmental Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan
| | - Chia-Fang Wu
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan; International Master Program of Translational Medicine, College of Engineering and Science, National United University, Miaoli, Taiwan.
| | - Ming-Tsang Wu
- PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan; Research Center for Precision Environmental Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan; Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City, 807, Taiwan; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tusty-Jiuan Hsieh
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan
| | - Chiung-Yu Peng
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan; Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City, 807, Taiwan
| | - Po-Chin Huang
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes (NHRI), Miaoli County, 35053, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Anbarasu Krishnan
- Department of Computational Biology, Institute of Bioinformatics, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, 602105, India
| | - Pei-Chien Tsai
- Department of Computational Biology, Institute of Bioinformatics, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, 602105, India; Department of Medicinal and Applied Chemistry, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan
| | - Yu-Chia Lin
- Research and Development Division, Great Engineering Technology (GETECH) Corporation, No.392, Yucheng Rd., Zuoying District., Kaohsiung City, 813, Taiwan
| | - Bongee Tsai
- Research and Development Division, Great Engineering Technology (GETECH) Corporation, No.392, Yucheng Rd., Zuoying District., Kaohsiung City, 813, Taiwan
| | - Yuan-Chung Lin
- Center for Emerging Contaminants Research, National Sun Yat-Sen University, Kaohsiung City, 804, Taiwan; Institute of Environmental Engineering, National Sun Yat-Sen University, Kaohsiung City, 804, Taiwan
| | - Vinoth Kumar Ponnusamy
- PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan; Research Center for Precision Environmental Medicine, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan; Department of Medicinal and Applied Chemistry, Kaohsiung Medical University (KMU), Kaohsiung City, 807, Taiwan; Center for Emerging Contaminants Research, National Sun Yat-Sen University, Kaohsiung City, 804, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital (KMUH), Kaohsiung Medical University, Kaohsiung City, 807, Taiwan.
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Zailani NNB, Ho PCL. Dried Blood Spots-A Platform for Therapeutic Drug Monitoring (TDM) and Drug/Disease Response Monitoring (DRM). Eur J Drug Metab Pharmacokinet 2023; 48:467-494. [PMID: 37495930 PMCID: PMC10480258 DOI: 10.1007/s13318-023-00846-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/28/2023]
Abstract
This review provides an overview on the current applications of dried blood spots (DBS) as matrices for therapeutic drug (TDM) and drug or disease response monitoring (DRM). Compared with conventional methods using plasma/serum, DBS offers several advantages, including minimally invasiveness, a small blood volume requirement, reduced biohazardous risk, and improved sample stability. Numerous assays utilising DBS for TDM have been reported in the literature over the past decade, covering a wide range of therapeutic drugs. Several factors can affect the accuracy and reliability of the DBS sampling method, including haematocrit (HCT), blood volume, sampling paper and chromatographic effects. It is crucial to evaluate the correlation between DBS concentrations and conventional plasma/serum concentrations, as the latter has traditionally been used for clinical decision. The feasibility of using DBS sampling method as an option for home-based TDM is also discussed. Furthermore, DBS has also been used as a matrix for monitoring the drug or disease responses (DRM) through various approaches such as genotyping, viral load measurement, assessment of inflammatory factors, and more recently, metabolic profiling. Although this research is still in the development stage, advancements in technology are expected to lead to the identification of surrogate biomarkers for drug treatment in DBS and a better understanding of the correlation between DBS drug levels and drug responses. This will make DBS a valuable matrix for TDM and DRM, facilitating the achievement of pharmacokinetic and pharmacodynamic correlations and enabling personalised therapy.
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Affiliation(s)
- Nur Nabihah Binte Zailani
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Paul Chi-Lui Ho
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore.
- School of Pharmacy, Monash University Malaysia, Level 5, Building 2, 47500, Bandar Sunway, Selangor Darul Ehsan, Malaysia.
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Yi ZM, Li X, Wang Z, Qin J, Jiang D, Tian P, Yang P, Zhao R. Status and Quality of Guidelines for Therapeutic Drug Monitoring Based on AGREE II Instrument. Clin Pharmacokinet 2023; 62:1201-1217. [PMID: 37490190 DOI: 10.1007/s40262-023-01283-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND With the progress of therapeutic drug monitoring (TDM) technology and the development of evidence-based medicine, many guidelines were developed and implemented in recent decades. OBJECTIVE The aim was to evaluate the current status of TDM guidelines and provide suggestions for their development and updates based on Appraisal of Guidelines for Research and Evaluation (AGREE) II. METHODS The TDM guidelines were systematically searched for among databases including PubMed, Embase, China National Knowledge Infrastructure, Wanfang Data, and the Chinese biomedical literature service system and the official websites of TDM-related associations. The search period was from inception to 6 April 2023. Four researchers independently screened the literature and extracted data. Any disagreement was discussed and reconciled by another researcher. The quality of guidelines was assessed using the AGREE II instrument. RESULTS A total of 92 guidelines were included, including 57 technical guidelines, three management guidelines, and 32 comprehensive guidelines. The number of TDM guidelines has gradually increased since 1979. The United States published the most guidelines (20 guidelines), followed by China (15 guidelines) and the United Kingdom (ten guidelines), and 23 guidelines were developed by international organizations. Most guidelines are aimed at adult patients only, while 28 guidelines include special populations. With respect to formulation methods, there are 23 evidence-based guidelines. As for quality evaluation results based on AGREE II, comprehensive guidelines scored higher (58.16%) than technical guidelines (51.36%) and administrative guidelines (50.00%). CONCLUSION The number of TDM guidelines, especially technical and comprehensive ones, has significantly increased in recent years. Most guidelines are confronted with the problems of unclear methodology and low quality of evidence according to AGREE II. More evidence-based research on TDM and high-quality guideline development is recommended to promote individualized therapy.
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Affiliation(s)
- Zhan-Miao Yi
- Department of Pharmacy, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Xinya Li
- Department of Pharmacy, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Zhitong Wang
- Department of Pharmacy, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Jiguang Qin
- Department of Pharmacy, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Dan Jiang
- Department of Pharmacy, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Panhui Tian
- Department of Pharmacy, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Ping Yang
- Department of Pharmacy, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China.
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Nugraha RV, Yunivita V, Santoso P, Hasanah AN, Aarnoutse RE, Ruslami R. Analytical and Clinical Validation of Assays for Volumetric Absorptive Microsampling (VAMS) of Drugs in Different Blood Matrices: A Literature Review. Molecules 2023; 28:6046. [PMID: 37630297 PMCID: PMC10459922 DOI: 10.3390/molecules28166046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Volumetric absorptive microsampling (VAMS) is the newest and most promising sample-collection technique for quantitatively analyzing drugs, especially for routine therapeutic drug monitoring (TDM) and pharmacokinetic studies. This technique uses an absorbent white tip to absorb a fixed volume of a sample (10-50 µL) within a few seconds (2-4 s), is more flexible, practical, and more straightforward to be applied in the field, and is probably more cost-effective than conventional venous sampling (CVS). After optimization and validation of an analytical method of a drug taken by VAMS, a clinical validation study is needed to show that the results by VAMS can substitute what is gained from CVS and to justify implementation in routine practice. This narrative review aimed to assess and present studies about optimization and analytical validation of assays for drugs taken by VAMS, considering their physicochemical drug properties, extraction conditions, validation results, and studies on clinical validation of VAMS compared to CVS. The review revealed that the bio-analysis of many drugs taken with the VAMS technique was optimized and validated. However, only a few clinical validation studies have been performed so far. All drugs that underwent a clinical validation study demonstrated good agreement between the two techniques (VAMS and CVS), but only by Bland-Altman analysis. Only for tacrolimus and mycophenolic acid were three measurements of agreement evaluated. Therefore, VAMS can be considered an alternative to CVS in routine practice, especially for tacrolimus and mycophenolic acid. Still, more extensive clinical validation studies need to be performed for other drugs.
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Affiliation(s)
- Rhea Veda Nugraha
- Doctoral Study Program, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia;
| | - Vycke Yunivita
- Division of Pharmacology and Therapy, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia;
| | - Prayudi Santoso
- Division of Respirology and Critical Care, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran—Hasan Sadikin Hospital, Bandung 40161, Indonesia;
| | - Aliya Nur Hasanah
- Department of Pharmaceutical Analysis and Medicinal Chemistry, Faculty of Pharmacy, Universitas Padjadjaran, Bandung 45363, Indonesia;
| | - Rob E. Aarnoutse
- Department of Pharmacy, Radboud University Medical Center, Research Institute for Medical Innovation, 6255 HB Nijmegen, The Netherlands;
| | - Rovina Ruslami
- Division of Pharmacology and Therapy, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia;
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40
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Daousani C, Karalis V, Loukas YL, Schulpis KH, Alexiou K, Dotsikas Y. Dried Blood Spots in Neonatal Studies: A Computational Analysis for the Role of the Hematocrit Effect. Pharmaceuticals (Basel) 2023; 16:1126. [PMID: 37631041 PMCID: PMC10459320 DOI: 10.3390/ph16081126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/29/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Dried blood spot (DBS) microsampling is extensively employed in newborn screening (NBS) and neonatal studies. However, the impact of variable neonatal hematocrit (Ht) values on the results can be a source of analytical error, and the use of fixed Ht for calibration (Htcal) is not representative of all neonatal subpopulations. A computational approach based on neonatal demographics was developed and implemented in R® language to propose a strategy using correction factors to address the Ht effect in neonatal DBS partial-spot assays. A rational "tolerance level" was proposed for the Ht effect contribution to the total analytical error and a safe Ht range for neonatal samples, where the correction of concentrations can be omitted. Furthermore, an "alert zone" for a false positive or negative result in NBS was proposed, where the Ht effect has to be considered. Results point toward the use of Htcal values closely representative of populations under analysis and an acceptable level of percentage relative error can be attributed to the Ht effect, diminishing the probability of correction. Overall, the impact of the Ht effect on neonatal studies is important and future work may further investigate this parameter, correlated to other clinical variables potentially affecting results.
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Affiliation(s)
- Chrysa Daousani
- Laboratory of Pharmaceutical Analysis, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, 157 84 Athens, Greece
| | - Vangelis Karalis
- Laboratory of Biopharmaceutics-Pharmacokinetics, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, 157 84 Athens, Greece
| | - Yannis L. Loukas
- Laboratory of Pharmaceutical Analysis, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, 157 84 Athens, Greece
| | | | | | - Yannis Dotsikas
- Laboratory of Pharmaceutical Analysis, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, 157 84 Athens, Greece
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Monchaud C, Woillard JB, Crépin S, Tafzi N, Micallef L, Rerolle JP, Dharancy S, Conti F, Choukroun G, Thierry A, Buchler M, Salamé E, Garrouste C, Duvoux C, Colosio C, Merville P, Anglicheau D, Etienne I, Saliba F, Mariat C, Debette-Gratien M, Marquet P. Tacrolimus Exposure Before and After a Switch From Twice-Daily Immediate-Release to Once-Daily Prolonged Release Tacrolimus: The ENVARSWITCH Study. Transpl Int 2023; 36:11366. [PMID: 37588007 PMCID: PMC10425592 DOI: 10.3389/ti.2023.11366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/06/2023] [Indexed: 08/18/2023]
Abstract
LCP-tacrolimus displays enhanced oral bioavailability compared to immediate-release (IR-) tacrolimus. The ENVARSWITCH study aimed to compare tacrolimus AUC0-24 h in stable kidney (KTR) and liver transplant recipients (LTR) on IR-tacrolimus converted to LCP-tacrolimus, in order to re-evaluate the 1:0.7 dose ratio recommended in the context of a switch and the efficiency of the subsequent dose adjustment. Tacrolimus AUC0-24 h was obtained by Bayesian estimation based on three concentrations measured in dried blood spots before (V2), after the switch (V3), and after LCP-tacrolimus dose adjustment intended to reach the pre-switch AUC0-24 h (V4). AUC0-24 h estimates and distributions were compared using the bioequivalence rule for narrow therapeutic range drugs (Westlake 90% CI within 0.90-1.11). Fifty-three KTR and 48 LTR completed the study with no major deviation. AUC0-24 h bioequivalence was met in the entire population and in KTR between V2 and V4 and between V2 and V3. In LTR, the Westlake 90% CI was close to the acceptance limits between V2 and V4 (90% CI = [0.96-1.14]) and between V2 and V3 (90% CI = [0.96-1.15]). The 1:0.7 dose ratio is convenient for KTR but may be adjusted individually for LTR. The combination of DBS and Bayesian estimation for tacrolimus dose adjustment may help with reaching appropriate exposure to tacrolimus rapidly after a switch.
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Affiliation(s)
- Caroline Monchaud
- Department of Pharmacology, Toxicology and Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France
- INSERM1248 Pharmacolgy and Transplantation, Limoges, France
- Fédération Hospitalo-Universitaire Survival Optimization in Organ Transplantation (FHU SUPORT), Limoges, France
| | - Jean-Baptiste Woillard
- Department of Pharmacology, Toxicology and Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France
- INSERM1248 Pharmacolgy and Transplantation, Limoges, France
- Fédération Hospitalo-Universitaire Survival Optimization in Organ Transplantation (FHU SUPORT), Limoges, France
| | - Sabrina Crépin
- Department of Pharmacology, Toxicology and Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France
- INSERM1248 Pharmacolgy and Transplantation, Limoges, France
- Fédération Hospitalo-Universitaire Survival Optimization in Organ Transplantation (FHU SUPORT), Limoges, France
- Unité de Vigilance des Essais Cliniques, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Naïma Tafzi
- Department of Pharmacology, Toxicology and Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Ludovic Micallef
- Department of Pharmacology, Toxicology and Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France
- Fédération Hospitalo-Universitaire Survival Optimization in Organ Transplantation (FHU SUPORT), Limoges, France
| | - Jean-Philippe Rerolle
- INSERM1248 Pharmacolgy and Transplantation, Limoges, France
- Fédération Hospitalo-Universitaire Survival Optimization in Organ Transplantation (FHU SUPORT), Limoges, France
- Department of Nephrology, Dialysis and Transplantation, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | | | - Filomena Conti
- Department of Hepato-Gastro-Enterology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Gabriel Choukroun
- Department of Nephrology, Internal Medicine, Transplantation, Centre Hospitalier Universitaire (CHU) d'Amiens, Amiens, France
| | - Antoine Thierry
- Fédération Hospitalo-Universitaire Survival Optimization in Organ Transplantation (FHU SUPORT), Poitiers, France
- Department of Nephrology, Hemodialysis and Renal Transplantation, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
| | - Matthias Buchler
- Fédération Hospitalo-Universitaire Survival Optimization in Organ Transplantation (FHU SUPORT), Tours, France
- Department of Nephrology–Arterial Hypertension, Dialyses, Renal Transplantation, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Ephrem Salamé
- Fédération Hospitalo-Universitaire Survival Optimization in Organ Transplantation (FHU SUPORT), Tours, France
- Center for Hepatobiliary and Pancreatic Surgery, Hepatic Transplantation, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Cyril Garrouste
- Department of Nephrology–Hemodialyses, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Christophe Duvoux
- Department of Hepatology, Hôpital Henri-Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Charlotte Colosio
- Department of Nephrology, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Pierre Merville
- Department of Nephrology, Transplantation, Dialysis and Aphereses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Dany Anglicheau
- Department of Kidney and Metabolism Diseases, Transplantation and Clinical Immunology, Hôpital Necker-Enfants Malades, Paris, France
| | - Isabelle Etienne
- Department of Nephrology, Hemodialysis, Transplantation, Centre Hospitalier Universitaire (CHU) de Rouen, Rouen, France
| | | | - Christophe Mariat
- Department of Nephrology, Dialysis and Renal Transplantation, Centre Hospitalier Universitaire (CHU) de Saint-Étienne, Saint-Etienne, France
| | - Marilyne Debette-Gratien
- INSERM1248 Pharmacolgy and Transplantation, Limoges, France
- Fédération Hospitalo-Universitaire Survival Optimization in Organ Transplantation (FHU SUPORT), Limoges, France
- Department of Hepato-Gastro-Enterology and Nutrition, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Pierre Marquet
- Department of Pharmacology, Toxicology and Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France
- INSERM1248 Pharmacolgy and Transplantation, Limoges, France
- Fédération Hospitalo-Universitaire Survival Optimization in Organ Transplantation (FHU SUPORT), Limoges, France
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Herrera-Pérez IG, Rodríguez-Báez AS, Ortiz-Álvarez A, Velarde-Salcedo R, Arriaga-García FJ, Rodríguez-Pinal CJ, Romano-Moreno S, Milán-Segovia RDC, Medellín-Garibay SE. Standardization and validation of a novel UPLC-MS/MS method to quantify first line anti-tuberculosis drugs in plasma and dried blood spots. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1228:123801. [PMID: 37453389 DOI: 10.1016/j.jchromb.2023.123801] [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: 02/03/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
Tuberculosis (TB) is a high-burden infectious disease with high prevalence and mortality rates. The first-line anti-TB drugs include isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA), and ethambutol (EMB). At present, the standard method of blood sampling for therapeutic drug monitoring (TDM) analysis is venipuncture. Dried blood spots (DBS) are a minimally invasive method for collecting small quantities of whole blood from fingertips. The aim of the current study was to develop an ultrahigh-performance liquid chromatography technique coupled to tandem mass spectrometry (UPLC-MS/MS) for simultaneous quantification of the first-line anti-TB drugs in human plasma and DBS as a sampling alternative. The separation and detection conditions were optimized to quantify INH, RMP, PZA, and EMB in both matrices in an ACQUITY UPLC H Class system coupled to a XEVO TQD detector. Chromatographic separation was performed through an Acquity HSS T3 column (2.1 × 100 mm, 1.8 μm) with 0.1% formic acid in water and acetonitrile as the mobile phase. The total run time was 7 min for both methods, with retention time in plasma of 0.85, 1.22, 3.16, and 4.04 min and 0.74, 0.87, 0.97, and 4.16 min for EMB, INH, PZA, and RMP in DBS, respectively. The bioanalytical methods developed were proved selective, linear, precise, and accurate (inter- and intra-assay); the matrix effect was demonstrated to be within the established limits. Short- and long-term stability, freeze-thaw cycles for plasma, and short-term stability for DBS were established. A total of 15 patients with 46 ± 17 (mean ± SD) years old were included, and anti-TB drug concentrations were quantified on plasma and DBS as proof of concept. Based on RMP and INH plasma concentrations (Cp), and Bayesian estimation of individual pharmacokinetic parameters, a dose adjustment was necessary for 93% of patients. The slopes of the correlation lines between plasma and DBS concentrations of RMP, EMB, INH, and PZA were 0.5321, 0.8125, 0.5680, and 0.6791, respectively. Finally, significant correlations (p < 0.05) were observed between DBS and plasma concentrations for RMP (r2 = 0.6961), EMB (r2 = 0.4369), INH (r2 = 0.8675) and PZA (r2 = 0.7363). A simple, fast, and reliable UPLC-MS/MS method was developed to quantify first-line anti-TB drugs in plasma and DBS, which provides an easy sampling and storage to be applied as a new strategy for TDM in patients with TB.
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Affiliation(s)
| | | | - Arturo Ortiz-Álvarez
- Servicio de Infectología, Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, S.L.P, Mexico
| | | | | | | | - Silvia Romano-Moreno
- Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, S.L.P, Mexico
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Kocur A, Rubik J, Czarnowski P, Czajkowska A, Marszałek D, Sierakowski M, Górska M, Pawiński T. Therapeutic drug monitoring of mycophenolic acid (MPA) using volumetric absorptive microsampling (VAMS) in pediatric renal transplant recipients: ultra-high-performance liquid chromatography-tandem mass spectrometry analytical method development, cross-validation, and clinical application. Pharmacol Rep 2023:10.1007/s43440-023-00509-w. [PMID: 37452967 PMCID: PMC10374821 DOI: 10.1007/s43440-023-00509-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Mycophenolic acid (MPA) is widely used in posttransplant pharmacotherapy for pediatric patients after renal transplantation. Volumetric absorptive microsampling (VAMS) is a recent approach for sample collection, particularly during therapeutic drug monitoring (TDM). The recommended matrix for MPA determination is plasma (PL), and conversion between capillary-blood VAMS samples and PL concentrations is required for the appropriate interpretation of the results. METHODS This study aimed to validate and develop a UHPLC-MS/MS method for MPA quantification in whole blood (WB), PL, and VAMS samples, with cross and clinical validation based on regression calculations. Methods were validated in the 0.10-15 µg/mL range for trough MPA concentration measurement according to the European Medicines Agency (EMA) guidelines. Fifty pediatric patients treated with MPA after renal transplantation were included in this study. PL and WB samples were obtained via venipuncture, whereas VAMS samples were collected after the fingerstick. The conversion from VAMSMPA to PLMPA concentration was performed using formulas based on hematocrit values and a regression model. RESULTS LC-MS/MS methods were successfully developed and validated according to EMA guidelines. The cross-correlation between the methods was evaluated using Passing-Bablok regression, Bland-Altman bias plots, and predictive performance calculations. Clinical validation of the developed method was successfully performed, and the formula based on regression was successfully validated for VAMSMPA to PLMPA concentration and confirmed on an independent group of samples. CONCLUSIONS This study is the first development of a triple matrix-based LC-MS/MS method for MPA determination in the pediatric population after renal transplantation. For the first time, the developed methods were cross-validated with routinely used HPLC-DAD protocol.
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Affiliation(s)
- Arkadiusz Kocur
- Department of Drug Chemistry, Medical University of Warsaw, 1 Banacha St, 02-091, Warsaw, Poland.
- Pharmacokinetics Laboratory, Department of Biochemistry, Radioimmunology, and Experimental Medicine, The Children's Memorial Health Institute, Dzieci Polskich 20, 04-730, Warsaw, Poland.
| | - Jacek Rubik
- Department of Nephrology, Kidney Transplantation, and Arterial Hypertension, The Children's Memorial Health Institute, Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Paweł Czarnowski
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland
| | - Agnieszka Czajkowska
- Pharmacokinetics Laboratory, Department of Biochemistry, Radioimmunology, and Experimental Medicine, The Children's Memorial Health Institute, Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Dorota Marszałek
- Department of Drug Chemistry, Medical University of Warsaw, 1 Banacha St, 02-091, Warsaw, Poland
| | - Maciej Sierakowski
- Institute of Biological Sciences, Cardinal Stefan Wyszynski University, 1/3 Kazimierza Wóycickiego St, 01-938, Warsaw, Poland
| | - Marta Górska
- Pharmacokinetics Laboratory, Department of Biochemistry, Radioimmunology, and Experimental Medicine, The Children's Memorial Health Institute, Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Tomasz Pawiński
- Department of Drug Chemistry, Medical University of Warsaw, 1 Banacha St, 02-091, Warsaw, Poland
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44
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Müller IR, Linden G, Charão MF, Antunes MV, Linden R. Dried blood spot sampling for therapeutic drug monitoring: challenges and opportunities. Expert Rev Clin Pharmacol 2023; 16:691-701. [PMID: 37300458 DOI: 10.1080/17512433.2023.2224562] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/08/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The use of dried blood spots (DBS) has gained interest in the field of therapeutic drug monitoring (TDM) due to its potential advantages, such as minimally invasive capillary blood collection, potential stabilization of drugs and metabolites at room or high temperatures, and lower biohazard, allowing for inexpensive storage and transportation. However, there are several drawbacks to the clinical use of DBS in TDM, mostly related to hematocrit (Hct) effects, differences between venous and capillary blood concentrations, among others, that must be evaluated during analytical and clinical method validation. AREA COVERED This review focuses on the most recent publications on the applications of DBS sampling for TDM (2016-2022), with a special focus on the challenges presented by this alternative sampling strategy, as well as the opportunities for clinical applications. Real-life studies presenting clinical applications were reviewed. EXPERT OPINION With the availability of method development and validation guidelines for DBS-based methods in TDM, higher levels of assay validation standardization have been achieved, expanding the clinical applications of DBS sampling in patient care. New sampling devices that overcome the limitations of classical DBS, such as the Hct effects, will further encourage the use of DBS in routine TDM.
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Affiliation(s)
| | - Gabriel Linden
- Laboratory of Analytical Toxicology, Universidade Feevale, Novo Hamburgo, Brazil
| | | | | | - Rafael Linden
- Laboratory of Analytical Toxicology, Universidade Feevale, Novo Hamburgo, Brazil
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Inoue Y, Sato Y, Kashiwagi H, Nashimoto S, Sugawara M, Takekuma Y. Monitoring Salivary Concentrations of Tedizolid and Linezolid Using Rats. Eur J Drug Metab Pharmacokinet 2023:10.1007/s13318-023-00836-6. [PMID: 37368188 DOI: 10.1007/s13318-023-00836-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Therapeutic drug monitoring (TDM) is an effective tool for the management of patients who are administered linezolid. The use of saliva for TDM has potential advantages over the use of plasma; however, only a few reports have compared drug concentrations in the saliva and plasma. Moreover, there are no reports on the salivary concentration of tedizolid, an oxazolidinone antibiotic similar to linezolid. In the present study, the concentrations of tedizolid and linezolid in rat submandibular saliva were compared with those measured in the plasma. METHODS Tedizolid (10 mg/kg, n = 6) and linezolid (12 mg/kg, n = 5) were administered via the rat tail vein. Submandibular saliva and plasma samples were collected for up to 8 h after the initiation of drug administration, and assayed for the concentrations of tedizolid and linezolid. RESULTS A strong correlation was found between the saliva and plasma concentrations of tedizolid (r = 0.964, p < 0.001) and linezolid (r = 0.936, p < 0.001). The value of tedizolid maximum concentration of drug (Cmax) was 0.99 ± 0.08 µg/mL in the saliva and 14.46 ± 1.71 µg/mL in the plasma. Meanwhile, the Cmax of linezolid was 8.01 ± 1.42 µg/mL in the saliva and 13.00 ± 1.90 µg/mL in the plasma. According to these results, the saliva/plasma concentration ratios of tedizolid and linezolid in rats were 0.0513 ± 0.0080 and 0.6341 ± 0.0339, respectively. CONCLUSIONS Considering the correlation between saliva and plasma concentrations of tedizolid and linezolid, as well as the characteristics of saliva, the results of this study suggest that saliva is a useful matrix for TDM.
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Affiliation(s)
- Yuki Inoue
- Graduate School of Life Science, Hokkaido University, Kita 10-jo, Nishi 8-chome, Kita-ku, Sapporo, 060-0810, Japan
| | - Yuki Sato
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo, Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Hitoshi Kashiwagi
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo, Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Shunsuke Nashimoto
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo, Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Mitsuru Sugawara
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo, Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
- Global Station for Biosurfaces and Drug Discovery, Hokkaido University, Kita 12-jo, Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan.
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Linden G, Charão MF, Linden R. Evaluation of the HealthID PSD microsampling device for the simultaneous determination of cholesterol, high-density lipoprotein, triglycerides, creatinine, and HbA 1c in capillary blood. Clin Biochem 2023:110597. [PMID: 37307936 DOI: 10.1016/j.clinbiochem.2023.110597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The use of dried capillary microsamples for clinical chemistry testing is an interesting alternative to conventional phlebotomy. Sampling devices capable to produce plasma from whole blood application are particularly useful. The aim of this study was to validate theHealthID PSDmicrosampling device for the determination of cholesterol (CHOL), high-density lipoprotein (HDL), triglycerides (TRIG), creatinine (CRE), and glycated hemoglobin (HbA1c) after collection of capillary blood. METHODS Dried blood and plasma extracts were analyzed using modified methods in an open-channel biochemistry analyzer. The plasma volume in the extracts was corrected by the concentration of chloride (CL). Linearity, imprecision, bias, stability, and comparability to conventional samples were evaluated. RESULTS Dried plasma assays presented total error (TE) within acceptable limits. The analytes were stable for up to 14 days at 40 °C. Predicted serum concentrations of CHO, HDL, TRI, and CRE and predicted whole blood levels of HbA1c, using dried extracts measurements, did not presented systematic or proportional differences to serum and whole blood levels. CONCLUSIONS Dried sample extracts obtained with capillary blood applied to the HealthID PSD allowed the determination of CHO, HDL, TRI, CRE, and HbA1c, as well as the calculation of LDL level, using only 5 drops of blood. This sampling strategy can be useful for population screening programs, particularly in Developing Countries.
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Affiliation(s)
| | - Mariele Feiffer Charão
- HealthID Lab, Campo Bom, RS, Brazil; Graduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Novo Hamburgo, RS, Brazil
| | - Rafael Linden
- HealthID Lab, Campo Bom, RS, Brazil; Graduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Novo Hamburgo, RS, Brazil.
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47
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Chaudhari BB, Devadiga BH, Matcha S, Lewis LE, Mallayasamy S, Moorkoth S. Validated HPLC method for ceftriaxone from dried blood spots for pharmacokinetic studies and therapeutic drug monitoring in neonatal population. Bioanalysis 2023. [PMID: 37216211 DOI: 10.4155/bio-2023-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Background: Pharmacokinetic evaluation is essential for the precise dosing of ceftriaxone in neonates. There is a need for developing a sensitive, affordable and convenient analytical method that can estimate ceftriaxone from dried blood spot (DBS) samples of neonates. Method: An HPLC-UV method was developed and validated as per ICH M10 for ceftriaxone from DBS and plasma using an Inertsil-ODS-3V column with gradient elution. DBS samples were extracted with methanol. Clinical validation was performed using neonatal samples. Results: The developed plasma- and DBS-based-HPLC method were linear from 2-700 μg/ml and 2-500 μg/ml, respectively, for ceftriaxone. Bland-Altman analysis indicated a strong interconvertibility between the plasma and DBS assays. Conclusion: Observed concentrations in clinical samples were comparable to the predicted concentrations, proving the clinical validity of the method.
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Affiliation(s)
- Bhim B Chaudhari
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Bhagyashree H Devadiga
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Saikumar Matcha
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Leslie Es Lewis
- Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Surulivelrajan Mallayasamy
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Sudheer Moorkoth
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Canil G, Orleni M, Posocco B, Gagno S, Bignucolo A, Montico M, Roncato R, Corsetti S, Bartoletti M, Toffoli G. LC-MS/MS Method for the Quantification of PARP Inhibitors Olaparib, Rucaparib and Niraparib in Human Plasma and Dried Blood Spot: Development, Validation and Clinical Validation for Therapeutic Drug Monitoring. Pharmaceutics 2023; 15:pharmaceutics15051524. [PMID: 37242766 DOI: 10.3390/pharmaceutics15051524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Poly (ADP-ribose) polymerase inhibitors (PARPis) are becoming increasingly meaningful in oncology, and their therapeutic drug monitoring (TDM) might be beneficial for patients. Several bioanalytical methods have been reported for PARPis quantification in human plasma, but advantages might be obtained using dried blood spot (DBS) as a sampling technique. Our aim was to develop and validate a liquid chromatography-tandem mass spectrometric (LC-MS/MS) method for olaparib, rucaparib, and niraparib quantification in both human plasma and DBS matrices. Additionally, we aimed to assess the correlation between the drug concentrations measured in these two matrices. DBS from patients was obtained using Hemaxis DB10 for volumetric sampling. Analytes were separated on a Cortecs-T3 column and detected with electrospray ionization (ESI)-MS in positive ionization mode. Validation was performed according to the latest regulatory guidelines, in the range (ng/mL) 140-7000 for olaparib, 100-5000 for rucaparib, and 60-3000 for niraparib, within the hematocrit (Hct) range 29-45%. The Passing-Bablok and Bland-Altman statistical analyses revealed a strong correlation between plasma and DBS for olaparib and niraparib. However, due to the limited amount of data, it was challenging to establish a robust regression analysis for rucaparib. To ensure a more reliable assessment, additional samples are required. The DBS-to-plasma ratio was used as a conversion factor (CF) without considering any patient-related hematological parameters. These results provide a solid basis for the feasibility of PARPis TDM using both plasma and DBS matrices.
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Affiliation(s)
- Giovanni Canil
- Experimental and Clinical Pharmacology Unit, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Marco Orleni
- Experimental and Clinical Pharmacology Unit, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Doctoral School in Pharmacological Sciences, University of Padua, 35131 Padova, Italy
| | - Bianca Posocco
- Experimental and Clinical Pharmacology Unit, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Sara Gagno
- Experimental and Clinical Pharmacology Unit, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Alessia Bignucolo
- Experimental and Clinical Pharmacology Unit, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Marcella Montico
- Clinical Trial Office, CRO Aviano, National Cancer Institute, IRCSS, 33081 Aviano, Italy
| | - Rossana Roncato
- Experimental and Clinical Pharmacology Unit, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Serena Corsetti
- Department of Medical Oncology, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Michele Bartoletti
- Department of Medical Oncology, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology Unit, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
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Salah LM, Bushman LR, Brooks KM, Anderson PL, Kiser JJ. Development and validation of an LC-MS/MS method to quantify the alcohol biomarker phosphatidylethanol 16:0/18:1 in dried blood spots for clinical research purposes. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1223:123725. [PMID: 37120963 PMCID: PMC10335920 DOI: 10.1016/j.jchromb.2023.123725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
Phosphatidylethanol (PEth) is a group of phospholipids detectable in red blood cells exclusively following ethanol consumption. The primary PEth analog, PEth 16:0/18:1, has an extended half-life in red cells, providing a long window of detection and tremendous potential for the quantification of cumulative alcohol consumption. We developed and validated an LC/MS-MS method to quantify PEth 16:0/18:1 in dried blood spots (DBS) for clinical research purposes. Method development and validation followed FDA guidance but expanded on prior published methods through the evaluation of additional DBS-specific factors such as sample hematocrit, punch location, and spot volume. This method was applied to the quantification of PEth in participant samples.
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Affiliation(s)
- Lana M Salah
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, 12850 E Montview Blvd, MS C238-V20-4410, Aurora, CO 80045, USA.
| | - Lane R Bushman
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, 12850 E Montview Blvd, MS C238-V20-4410, Aurora, CO 80045, USA.
| | - Kristina M Brooks
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, 12850 E Montview Blvd, MS C238-V20-4410, Aurora, CO 80045, USA.
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, 12850 E Montview Blvd, MS C238-V20-4410, Aurora, CO 80045, USA.
| | - Jennifer J Kiser
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, 12850 E Montview Blvd, MS C238-V20-4410, Aurora, CO 80045, USA.
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Rosé G, Tafzi N, El Balkhi S, Rerolle JP, Debette-Gratien M, Marquet P, Saint-Marcoux F, Monchaud C. New perspectives for the therapeutic drug monitoring of tacrolimus: Quantification in volumetric DBS based on an automated extraction and LC-MS/MS analysis. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1223:123721. [PMID: 37120962 DOI: 10.1016/j.jchromb.2023.123721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/02/2023]
Abstract
Volumetric microsampling devices have been developed for home-based capillary blood sampling and are now increasingly proposed for the therapeutic drug monitoring (TDM) of immunosuppressive drugs. Our objective was to validate a LC-MS/MS method for tacrolimus quantification based on both a manual and an automated extraction of dried blood spots (DBS) collected with a volumetric microsampling device. DBS collection was performed by placing a drop of whole blood (WB) pre-spiked with tacrolimus onto a sealing film and placing the hemaPEN® device (Trajan Scientific and Medical, Melbourne, Australia) into the drop according to the device specifications. Tacrolimus was quantified using a fully automatic preparation module connected to a LCMS system (CLAM-3020® and LCMS-8060®, Shimadzu, Marne-la-Vallée, France). The method was validated analytically and clinically in accordance with the EMA and IATDMCT guidelines. The method was linear from 1 to 100 µg/L. Within- and between-run accuracy and precision fulfilled the validation criteria (biases and imprecision <15% or 20% for the lower limit of quantification). No hematocrit effect, matrix effect or carry-over was observed. No selectivity issue was identified and dilution integrity was confirmed. Tacrolimus in DBS was stable for 14 days at room temperature and +4°C, and for 72h at +60°C. There was a good correlation between tacrolimus concentrations measured in WB and in DBS of 20 kidney and liver transplant recipients (r=0.93 and 0.87, for manual and automated extraction respectively). A method for tacrolimus measurement in DBS collected with volumetric micro-sampling device, based on a fully automated process from pre-treatment to LC-MS/MS analysis was developed and validated according to analytical and clinical criteria. This performing sampling and analytical procedure opens the perspective of an easier, faster and more efficient TDM of tacrolimus for patients, clinicians and laboratories.
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Affiliation(s)
- Gauthier Rosé
- Service de Pharmacologie, toxicologie et pharmacovigilance, CHU Limoges, Limoges, France
| | - Naïma Tafzi
- Service de Pharmacologie, toxicologie et pharmacovigilance, CHU Limoges, Limoges, France
| | - Souleiman El Balkhi
- Service de Pharmacologie, toxicologie et pharmacovigilance, CHU Limoges, Limoges, France; INSERM UMR-1248 « Pharmacologie et Transplantation », Université Limoges, Limoges, France; FHU SUPORT, Limoges, France
| | - Jean-Philippe Rerolle
- INSERM UMR-1248 « Pharmacologie et Transplantation », Université Limoges, Limoges, France; FHU SUPORT, Limoges, France; Service de Néphrologie, dialyse et transplantation, CHU Limoges, France
| | - Marilyne Debette-Gratien
- INSERM UMR-1248 « Pharmacologie et Transplantation », Université Limoges, Limoges, France; FHU SUPORT, Limoges, France; Service d'Hépato-gastro-entérologie et nutrition, CHU Limoges, Limoges, France
| | - Pierre Marquet
- Service de Pharmacologie, toxicologie et pharmacovigilance, CHU Limoges, Limoges, France; INSERM UMR-1248 « Pharmacologie et Transplantation », Université Limoges, Limoges, France; FHU SUPORT, Limoges, France
| | - Franck Saint-Marcoux
- Service de Pharmacologie, toxicologie et pharmacovigilance, CHU Limoges, Limoges, France; INSERM UMR-1248 « Pharmacologie et Transplantation », Université Limoges, Limoges, France; FHU SUPORT, Limoges, France
| | - Caroline Monchaud
- Service de Pharmacologie, toxicologie et pharmacovigilance, CHU Limoges, Limoges, France; INSERM UMR-1248 « Pharmacologie et Transplantation », Université Limoges, Limoges, France; FHU SUPORT, Limoges, France.
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