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Rao PS, Modi N, Nguyen NTT, Vu DH, Xie YL, Gandhi M, Gerona R, Metcalfe J, Heysell SK, Alffenaar JWC. Alternative Methods for Therapeutic Drug Monitoring and Dose Adjustment of Tuberculosis Treatment in Clinical Settings: A Systematic Review. Clin Pharmacokinet 2023; 62:375-398. [PMID: 36869170 PMCID: PMC10042915 DOI: 10.1007/s40262-023-01220-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Quantifying exposure to drugs for personalized dose adjustment is of critical importance in patients with tuberculosis who may be at risk of treatment failure or toxicity due to individual variability in pharmacokinetics. Traditionally, serum or plasma samples have been used for drug monitoring, which only poses collection and logistical challenges in high-tuberculosis burden/low-resourced areas. Less invasive and lower cost tests using alternative biomatrices other than serum or plasma may improve the feasibility of therapeutic drug monitoring. METHODS A systematic review was conducted to include studies reporting anti-tuberculosis drug concentration measurements in dried blood spots, urine, saliva, and hair. Reports were screened to include study design, population, analytical methods, relevant pharmacokinetic parameters, and risk of bias. RESULTS A total of 75 reports encompassing all four biomatrices were included. Dried blood spots reduced the sample volume requirement and cut shipping costs whereas simpler laboratory methods to test the presence of drug in urine can allow point-of-care testing in high-burden settings. Minimal pre-processing requirements with saliva samples may further increase acceptability for laboratory staff. Multi-analyte panels have been tested in hair with the capacity to test a wide range of drugs and some of their metabolites. CONCLUSIONS Reported data were mostly from small-scale studies and alternative biomatrices need to be qualified in large and diverse populations for the demonstration of feasibility in operational settings. High-quality interventional studies will improve the uptake of alternative biomatrices in guidelines and accelerate implementation in programmatic tuberculosis treatment.
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Affiliation(s)
- Prakruti S Rao
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Nisha Modi
- Global TB Institute and Department of Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Nam-Tien Tran Nguyen
- National Drug Information and Adverse Drug Reaction Monitoring Centre, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Dinh Hoa Vu
- National Drug Information and Adverse Drug Reaction Monitoring Centre, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Yingda L Xie
- Global TB Institute and Department of Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Roy Gerona
- Maternal-Fetal Medicine Division, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - John Metcalfe
- Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA
| | - Scott K Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Jan-Willem C Alffenaar
- Pharmacy School, The University of Sydney, Pharmacy Building (A15), Science Road, Sydney, NSW, 2006, Australia.
- The University of Sydney at Westmead Hospital, Sydney, NSW, Australia.
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, NSW, Australia.
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2
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Gerona R, Wen A, Aguilar D, Shum J, Reckers A, Bacchetti P, Gandhi M, Metcalfe J. Simultaneous analysis of 11 medications for drug resistant TB in small hair samples to quantify adherence and exposure using a validated LC-MS/MS panel. J Chromatogr B Analyt Technol Biomed Life Sci 2019; 1125:121729. [PMID: 31369929 DOI: 10.1016/j.jchromb.2019.121729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Roy Gerona
- Department of Obstetrics, Gynecology and Reproductive Sciences, TB Hair Analysis Laboratory, University of California, San Francisco (UCSF), San Francisco, CA, 94115, United States of America.
| | - Anita Wen
- Department of Obstetrics, Gynecology and Reproductive Sciences, TB Hair Analysis Laboratory, University of California, San Francisco (UCSF), San Francisco, CA, 94115, United States of America
| | - David Aguilar
- Department of Obstetrics, Gynecology and Reproductive Sciences, TB Hair Analysis Laboratory, University of California, San Francisco (UCSF), San Francisco, CA, 94115, United States of America
| | - Jamie Shum
- Department of Medicine, Hair Analysis Laboratory, University of California San Francisco (UCSF), San Francisco, CA 94143, United States of America
| | - Andrew Reckers
- Department of Obstetrics, Gynecology and Reproductive Sciences, TB Hair Analysis Laboratory, University of California, San Francisco (UCSF), San Francisco, CA, 94115, United States of America
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California San Francisco (UCSF), San Francisco, CA 94143, United States of America
| | - Monica Gandhi
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco (UCSF), San Francisco, CA 94110, United States of America
| | - John Metcalfe
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco (UCSF), San Francisco, CA 94110, United States of America
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Mave V, Chandanwale A, Kinikar A, Khadse S, Kagal A, Gupte N, Suryavanshi N, Nimkar S, Koli H, Khwaja S, Bharadwaj R, Joshi S, Horng H, Benet LZ, Ramachandran G, Dooley KE, Gupta A, Gandhi M. Isoniazid hair concentrations in children with tuberculosis: a proof of concept study. Int J Tuberc Lung Dis 2018; 20:844-7. [PMID: 27155191 PMCID: PMC4889729 DOI: 10.5588/ijtld.15.0882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Assessing treatment adherence and quantifying exposure to anti-tuberculosis drugs among children is challenging. We undertook a 'proof of concept' study to assess the drug concentrations of isoniazid (INH) in hair as a therapeutic drug monitoring tool. Children aged <12 years initiated on a thrice-weekly treatment regimen including INH (10 mg/kg) for newly diagnosed tuberculosis were enrolled. INH concentrations in hair were measured using liquid chromatography-tandem mass spectrometry at 1, 2, 4 and 6 months after initiating anti-tuberculosis treatment. We found that INH hair concentrations in all children on thrice-weekly INH were detectable and displayed variability across a dynamic range.
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Affiliation(s)
- V Mave
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Chandanwale
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - A Kinikar
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - S Khadse
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - A Kagal
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - N Gupte
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Suryavanshi
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - S Nimkar
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - H Koli
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - S Khwaja
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - R Bharadwaj
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - S Joshi
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - H Horng
- University of California, San Francisco, California, USA
| | - L Z Benet
- University of California, San Francisco, California, USA
| | - G Ramachandran
- National Institute of Research in Tuberculosis, Chennai, India
| | - K E Dooley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Gupta
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Gandhi
- University of California, San Francisco, California, USA
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4
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Mave V, Kinikar A, Kagal A, Nimkar S, Koli H, Khwaja S, Bharadwaj R, Gerona R, Wen A, Ramachandran G, Kumar H, Bacchetti P, Dooley KE, Gupte N, Gupta A, Gandhi M. Isoniazid concentrations in hair and plasma area-under-the-curve exposure among children with tuberculosis. PLoS One 2017; 12:e0189101. [PMID: 29216273 PMCID: PMC5720757 DOI: 10.1371/journal.pone.0189101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/17/2017] [Indexed: 11/21/2022] Open
Abstract
We measured hair and plasma concentrations of isoniazid among sixteen children with tuberculosis who underwent personal or video-assisted directly observed therapy and thus had 100% adherence. This study therefore defined typical isoniazid exposure parameters after two months of treatment among fully-adherent patients in both hair and plasma (plasma area under the concentration-time curve, AUC, estimated using pharmacokinetic data collected 0, 2, 4, and 6 hours after drug administration). We found that INH levels in hair among highly-adherent individuals did not correlate well with plasma AUC or trough concentrations, suggesting that each measure may provide incremental and complementary information regarding drug exposure in the context of TB treatment.
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Affiliation(s)
- Vidya Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Aarti Kinikar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Anju Kagal
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Smita Nimkar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Hari Koli
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Sultanat Khwaja
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Renu Bharadwaj
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Roy Gerona
- University of California San Francisco, San Francisco, United States of America
| | - Anita Wen
- University of California San Francisco, San Francisco, United States of America
| | | | - Hemanth Kumar
- National Institute of Research in Tuberculosis, Chennai, India
| | - Peter Bacchetti
- University of California San Francisco, San Francisco, United States of America
| | - Kelly E. Dooley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Nikhil Gupte
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Amita Gupta
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Monica Gandhi
- University of California San Francisco, San Francisco, United States of America
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Quantifying Isoniazid Levels in Small Hair Samples: A Novel Method for Assessing Adherence during the Treatment of Latent and Active Tuberculosis. PLoS One 2016; 11:e0155887. [PMID: 27191185 PMCID: PMC4871544 DOI: 10.1371/journal.pone.0155887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is the leading cause of death from an infectious pathogen worldwide and the most prevalent opportunistic infection in people living with HIV. Isoniazid preventive therapy (IPT) reduces the incidence of active TB and reduces morbidity and mortality in HIV-infected patients independently of antiretroviral therapy. However, treatment of latent or active TB is lengthy and inter-patient variability in pharmacokinetics and adherence common. Current methods of assessing adherence to TB treatment using drug levels in plasma or urine assess short-term exposure and pose logistical challenges. Drug concentrations in hair assess long-term exposure and have demonstrated pharmacodynamic relevance in HIV. METHODS A large hair sample from a patient with active TB was obtained for assay development. Methods to pulverize hair and extract isoniazid were optimized and then the drug detected by liquid chromatography/ tandem mass spectrometry (LC/MS-MS). The method was validated for specificity, accuracy, precision, recovery, linearity and stability to establish the assay's suitability for therapeutic drug monitoring (TDM). Hair samples from patients on directly-observe isoniazid-based latent or active TB therapy from the San Francisco Department of Public Health TB clinic were then tested. RESULTS Our LC/MS-MS-based assay detected isoniazid in quantities as low as 0.02ng/mg using 10-25 strands hair. Concentrations in spiked samples demonstrated linearity from 0.05-50ng/mg. Assay precision and accuracy for spiked quality-control samples were high, with an overall recovery rate of 79.5%. In 18 patients with latent or active TB on treatment, isoniazid was detected across a wide linear dynamic range. CONCLUSIONS An LC-MS/MS-based assay to quantify isoniazid levels in hair with performance characteristics suitable for TDM was developed and validated. Hair concentrations of isoniazid assess long-term exposure and may be useful for monitoring adherence to latent or active TB treatment in the setting of HIV.
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PharmGKB summary: very important pharmacogene information for N-acetyltransferase 2. Pharmacogenet Genomics 2014; 24:409-25. [PMID: 24892773 DOI: 10.1097/fpc.0000000000000062] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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