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Bharti V, Jung B, Lam S, Fabros A, Selvaratnam R. Stability and Analytical Characterization of Voriconazole as Measured by Immunoassay. J Appl Lab Med 2024; 9:565-572. [PMID: 38366039 DOI: 10.1093/jalm/jfad139] [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: 10/03/2023] [Accepted: 12/18/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Voriconazole is a broad-spectrum triazole antifungal agent recommended for invasive fungal diseases, including invasive aspergillosis. Therapeutic drug monitoring via voriconazole target trough concentration is important to ensure efficacy while preventing toxicity. Our aim was to determine the stability of voriconazole as adapted and measured by an immunoassay. METHODS Plasma from patient samples (n = 45) evaluated by a liquid chromatography with tandem mass spectrometry (LC-MS/MS) method was compared against an ARK immunoassay method, adapted and optimized on the Abbott Alinity c analyzer. Stability of voriconazole and analytical performance of ARK immunoassay was assessed, including functional sensitivity, limit of blank (LoB), limit of detection (LoD), and limit of quantification (LoQ), linearity, and precision. RESULTS ARK voriconazole immunoassay was highly correlated (Pearson R = 0.988) to the LC-MS/MS method, with an average bias of 0.09 mg/L (2%). CV at LoQ of 0.5 mg/L was 3.7% while the functional sensitivity was established at 0.05 mg/L. Overall imprecision with liquid quality control material obtained from ARK was 5.0%, 6.3%, and 5.9% at 1 mg/L, 5 mg/L, and 10 mg/L, respectively. Limit of blank and LoD were 0.02 mg/L and 0.05 mg/L, respectively. Voriconazole in lithium heparin plasma separator tube declines over time, with a decrease that is more evident near or above toxic concentrations. CONCLUSION Voriconazole collected in gel separation tubes declines over time, possibly due to absorptive properties. Voriconazole measurements by immunoassay and LC-MS/MS demonstrated acceptable comparability with sufficient level of sensitivity and precision.
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Affiliation(s)
- Veni Bharti
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Benjamin Jung
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Division of Clinical Biochemistry, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sarah Lam
- Division of Clinical Biochemistry, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Ansel Fabros
- Division of Clinical Biochemistry, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Rajeevan Selvaratnam
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Division of Clinical Biochemistry, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
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Stewart S, Dodero-Anillo JM, Guijarro-Eguinoa J, Arias P, Gómez López De Las Huertas A, Seco-Meseguer E, García-García I, Ramírez García E, Rodríguez-Antolín C, Carcas AJ, Rodriguez-Novoa S, Rosas-Alonso R, Borobia AM. Advancing pharmacogenetic testing in a tertiary hospital: a retrospective analysis after 10 years of activity. Front Pharmacol 2023; 14:1292416. [PMID: 37927587 PMCID: PMC10622662 DOI: 10.3389/fphar.2023.1292416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
The field of pharmacogenetics (PGx) holds great promise in advancing personalized medicine by adapting treatments based on individual genetic profiles. Despite its benefits, there are still economic, ethical and institutional barriers that hinder its implementation in our healthcare environment. A retrospective analysis approach of anonymized data sourced from electronic health records was performed, encompassing a diverse patient population and evaluating key parameters such as prescribing patterns and test results, to assess the impact of pharmacogenetic testing. A head-to-head comparison with previously published activity results within the same pharmacogenetic laboratory was also conducted to contrast the progress made after 10 years. The analysis revealed significant utilization of pharmacogenetic testing in daily clinical practice, with 1,145 pharmacogenetic tests performed over a 1-year period and showing a 35% growth rate increase over time. Of the 17 different medical departments that sought PGx tests, the Oncology department accounted for the highest number, representing 58.47% of all genotyped patients. A total of 1,000 PGx tests were requested for individuals susceptible to receive a dose modification based on genotype, and 76 individuals received a genotype-guided dose adjustment. This study presents a comprehensive descriptive analysis of real-world data obtained from a public tertiary hospital laboratory specialized in pharmacogenetic testing, and presents data that strongly endorse the integration of pharmacogenetic testing into everyday clinical practice.
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Affiliation(s)
- Stefan Stewart
- Clinical Pharmacology Department, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | | | | | - Pedro Arias
- Pharmacogenetics Laboratory, Genetics Department, La Paz University Hospital, Madrid, Spain
| | | | | | - Irene García-García
- Clinical Pharmacology Department, IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Elena Ramírez García
- Clinical Pharmacology Department, IdiPAZ, La Paz University Hospital, Madrid, Spain
- Pharmacology Department, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carlos Rodríguez-Antolín
- Experimental Therapies and Novel Biomarkers in Cancer, Hospital La Paz Institute for Health Research—IdiPAZ, Madrid, Spain
| | - Antonio J. Carcas
- Clinical Pharmacology Department, IdiPAZ, La Paz University Hospital, Madrid, Spain
- Pharmacology Department, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Sonia Rodriguez-Novoa
- Genetics of Metabolic Diseases Laboratory, Genetics Department, La Paz University Hospital, Madrid, Spain
| | - Rocio Rosas-Alonso
- Pharmacogenetics Laboratory, Genetics Department, La Paz University Hospital, Madrid, Spain
- Experimental Therapies and Novel Biomarkers in Cancer, Hospital La Paz Institute for Health Research—IdiPAZ, Madrid, Spain
| | - Alberto M. Borobia
- Clinical Pharmacology Department, IdiPAZ, La Paz University Hospital, Madrid, Spain
- Pharmacology Department, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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García-García I, Borobia AM. Current approaches and future strategies for the implementation of pharmacogenomics in the clinical use of azole antifungal drugs. Expert Opin Drug Metab Toxicol 2021; 17:509-514. [PMID: 33622115 DOI: 10.1080/17425255.2021.1890715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Irene García-García
- Clinical Pharmacology Department, La Paz University Hospital, School of Medicine, Universidad Autónoma de Madrid, IdiPAZ, Madrid, Spain
| | - Alberto M Borobia
- Clinical Pharmacology Department, La Paz University Hospital, School of Medicine, Universidad Autónoma de Madrid, IdiPAZ, Madrid, Spain
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Monserrat Villatoro J, García García I, Bueno D, de la Cámara R, Estébanez M, López de la Guía A, Abad-Santos F, Antón C, Mejía G, Otero MJ, Ramírez García E, Frías Iniesta J, Carcas A, Borobia AM. Randomised multicentre clinical trial to evaluate voriconazole pre-emptive genotyping strategy in patients with risk of aspergillosis: vorigenipharm study protocol. BMJ Open 2020; 10:e037443. [PMID: 33004392 PMCID: PMC7534724 DOI: 10.1136/bmjopen-2020-037443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Invasive aspergillosis is the most important cause of morbidity and mortality in patients with haematological diseases. At present, voriconazole is the first-line treatment for invasive fungal disease. The pharmacokinetic interindividual variability of voriconazole depends on genetic factors. CYP450 is involved in 70%-75% of total metabolism of voriconazole, mainly CYP3A4 and CYP2C19, with the remaining 25%-30% of metabolism conducted by monooxygenase flavins. CYP2C19 single nucleotide polymorphisms could explain 50%-55% of variability in voriconazole metabolism. MATERIALS AND METHODS The main objective is to compare efficiency of pre-emptive voriconazole genotyping with routine practice. The primary outcome is serum voriconazole on the fifth day within the therapeutic range. The secondary outcome is the combined variables of therapeutic failure and adverse events within 90 days of first administration, associated with voriconazole. A total of 146 patients at risk of invasive aspergillosis who will potentially receive voriconazole will be recruited, and CYP2C19 will be genotyped. If the patient ultimately receives voriconazole, they will be randomised (1:1 experimental/control). In the experimental arm, patients will receive a dose according to a pharmacogenetic algorithm, including CYP2C19 genotype and clinical and demographic information. In the control arm, patients will receive a dose according to clinical practice guidelines. In addition, a Spanish National Healthcare System (NHS) point-of-view cost-effectiveness evaluation will be performed. Direct cost calculations for each arm will be performed. CONCLUSION This trial will provide information about the viability and cost-effectiveness of the implementation of a pre-emptive voriconazole genotyping strategy in the Spanish NHS. ETHICS AND DISSEMINATION A Spanish version of this protocol has been evaluated and approved by the La Paz University Hospital Ethics Committee and the Spanish Agency of Medicines and Medical Devices. Trial results will be submitted for publication in an open peer-reviewed medical speciality-specific publication. TRIAL REGISTRATION NUMBER Eudra-CT: 2019-000376-41 and NCT04238884; Pre-results.
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Affiliation(s)
| | - Irene García García
- Clinical Pharmacology Department, Hospital Universitario La Paz IdiPAZ, Madrid, Spain
| | - David Bueno
- Pediatric Oncology and Haematology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Rafael de la Cámara
- Haematology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Miriam Estébanez
- Internal Medicine Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | | | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de la Princesa, Madrid, Spain
- Pharmacology Department, Universidad Autonoma de Madrid, Madrid, Spain
| | - Cristina Antón
- Health Technology Assessment Department, Universidad Francisco de Vitoria, Pozuelo de Alarcon, Madrid, Spain
| | - Gina Mejía
- Clinical Pharmacology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - María José Otero
- Haematology Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - Elena Ramírez García
- Clinical Pharmacology Department, Hospital Universitario La Paz IdiPAZ, Madrid, Spain
- Pharmacology Department, Universidad Autonoma de Madrid, Madrid, Spain
| | - Jesús Frías Iniesta
- Clinical Pharmacology Department, Hospital Universitario La Paz IdiPAZ, Madrid, Spain
- Pharmacology Department, Universidad Autonoma de Madrid, Madrid, Spain
| | - Antonio Carcas
- Clinical Pharmacology Department, Hospital Universitario La Paz IdiPAZ, Madrid, Spain
- Pharmacology Department, Universidad Autonoma de Madrid, Madrid, Spain
| | - Alberto M Borobia
- Clinical Pharmacology Department, Hospital Universitario La Paz IdiPAZ, Madrid, Spain
- Pharmacology Department, Universidad Autonoma de Madrid, Madrid, Spain
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