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Mansour B, Ngo C, Schlemmer D, Robidou P, Blondel J, Marin C, Noé G, Procureur A, Jamelot M, Gligorov J, Salem JE, Zahr N. Simultaneous quantification of four hormone therapy drugs by LC-MS/MS: Clinical applications in breast cancer patients. J Pharm Biomed Anal 2024; 242:116032. [PMID: 38367520 DOI: 10.1016/j.jpba.2024.116032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Aromatase inhibitors such as anastrozole, letrozole, exemestane and selective estrogen down-regulator (SERD) fulvestrant are used mostly to treat breast cancer estrogen receptor positive in post-menopausal women. These drugs are given either through the oral route or by intramuscular injection. They have shown great inter-individual variability with a risk of cardiometabolic disorders. Hence the importance of their therapeutic drug monitoring not only for exposure-efficacy but also exposure-toxicity. We describe here a LC-MS/MS method for the simultaneous quantification of anastrozole, letrozole, exemestane and fulvestrant in human plasma. MATERIAL AND METHODS Plasma samples were prepared by a single-step protein precipitation. The liquid chromatography system was paired with a triple quadrupole mass spectrometer. Quantification were achieved in Multiple Reactions Monitoring mode and the electrospray ionization was in positive mode. RESULTS The method demonstrated consistent analytical performance across various parameters, including linearity, specificity, sensitivity, matrix effect, upper and lower limits of quantification, extraction recovery, precision, accuracy, hemolysis effect, dilution integrity, and stability under different storage conditions, in accordance with established guidelines. The analysis time for each run was 4 min. Calibration curves exhibited linearity within the 1-100 ng/mL range, with correlation coefficients > 0.99 for the four analytes. Plasma concentrations from 42 patients were integrated into the selected calibration. Stability assessments indicated that the four drugs remained stable at - 20 °C for three months, 15 days under refrigeration, up to 7 days at room temperature, and after three freeze-thaw cycles. CONCLUSION We have developed and validated this quantitative method for therapeutic drug monitoring of those four hormone therapy drugs:anastrozole, letrozole, fulvestrant and exemestane. This method can be also used for future clinical pharmacokinetics /pharmacodynamics studies.
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Affiliation(s)
- Bochra Mansour
- AP-HP. Sorbonne Université, Laboratoire de suivi thérapeutique pharmacologique spécialisé, F-75013 Paris, France
| | - Clarice Ngo
- AP-HP Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology, CIC-1901, Pharmacokinetics and Therapeutic Drug Monitoring Unit, UMR-S 1166, F-75013 Paris, France
| | - Dimitri Schlemmer
- AP-HP. Sorbonne Université, Laboratoire de suivi thérapeutique pharmacologique spécialisé, F-75013 Paris, France
| | - Pascal Robidou
- AP-HP Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology, CIC-1901, Pharmacokinetics and Therapeutic Drug Monitoring Unit, UMR-S 1166, F-75013 Paris, France
| | - Juliette Blondel
- AP-HP Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology, CIC-1901, Pharmacokinetics and Therapeutic Drug Monitoring Unit, UMR-S 1166, F-75013 Paris, France
| | - Clémence Marin
- AP-HP Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology, CIC-1901, Pharmacokinetics and Therapeutic Drug Monitoring Unit, UMR-S 1166, F-75013 Paris, France
| | - Gaëlle Noé
- AP-HP Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology, CIC-1901, Pharmacokinetics and Therapeutic Drug Monitoring Unit, UMR-S 1166, F-75013 Paris, France
| | - Adrien Procureur
- AP-HP Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology, CIC-1901, Pharmacokinetics and Therapeutic Drug Monitoring Unit, UMR-S 1166, F-75013 Paris, France
| | - Mathieu Jamelot
- Department of Medical Oncology, Institut Universitaire de Cancérologie, Sorbonne University, AP-HP, Tenon Hospital, Paris, France
| | - Joseph Gligorov
- Department of Medical Oncology, Institut Universitaire de Cancérologie, Sorbonne University, AP-HP, Tenon Hospital, Paris, France
| | - Joe-Elie Salem
- AP-HP Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology, CIC-1901, Pharmacokinetics and Therapeutic Drug Monitoring Unit, UMR-S 1166, F-75013 Paris, France
| | - Noël Zahr
- AP-HP. Sorbonne Université, Laboratoire de suivi thérapeutique pharmacologique spécialisé, F-75013 Paris, France; AP-HP Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology, CIC-1901, Pharmacokinetics and Therapeutic Drug Monitoring Unit, UMR-S 1166, F-75013 Paris, France.
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Cancellerini C, Belotti LMB, Mohamed S, Solda' M, Esposito E, Bisulli F, Mostacci B, Vignatelli L, Tinuper P, Contin M, Licchetta L. Fingerprick volumetric absorptive microsampling for therapeutic drug monitoring of antiseizure medications: Reliability and real-life feasibility in epilepsy patients. J Pharm Biomed Anal 2024; 242:116065. [PMID: 38401349 DOI: 10.1016/j.jpba.2024.116065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
Volumetric absorptive microsampling (VAMS) is increasingly proposed as a clinically reliable therapeutic drug monitoring (TDM) sampling methodology. The study aimed to establish the reliability and real-life feasibility of patient self-collected capillary VAMS for TDM of antiseizure medication (ASMs), using plasma ASMs concentrations from venous blood as a reference standard. Nurses collected venous and capillary blood samples using VAMS. Afterward, persons with epilepsy (PWE) performed VAMS sampling by themselves. All samples were analyzed by UHPLC-MS/MS. We performed a cross-validation study, comparing ASMs concentrations obtained by VAMS nurses and patients' self-collected versus plasma through Bland-Altman analysis and Passing-Bablok regression. We enrolled 301 PWE (M: F 42.5%:57.5%; mean age 44±16 years), treated with 13 ASMs, providing a total of 464 measurements. Statistical analysis comparing VAMS self-collected versus plasma ASMs concentrations showed a bias close to zero and slope and intercept values indicating a good agreement for CBZ, LCS, LEV, LTG, OXC, PB, and PHT, while a systematic difference between the two methods was found for VPA, PMP, TPM and ZNS. This is the first study showing the reliability and feasibility of the real-world application of PWE self-collected VAMS for most of the ASMs considered, giving a promising basis for at-home VAMS applications.
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Affiliation(s)
- Chiara Cancellerini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCARE, Bologna, Italy
| | - Laura Maria Beatrice Belotti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCARE, Bologna, Italy
| | - Susan Mohamed
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCARE, Bologna, Italy
| | - Martina Solda'
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCARE, Bologna, Italy
| | - Erika Esposito
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCARE, Bologna, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCARE, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCARE, Bologna, Italy
| | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCARE, Bologna, Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Manuela Contin
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full member of the European Reference Network EpiCARE, Bologna, Italy
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Kato M, Maruyama S, Watanabe N, Yamada R, Suzaki Y, Ishida M, Kanno H. Preliminary Investigation of a Rapid and Feasible Therapeutic Drug Monitoring Method for the Real-Time Estimation of Blood Pazopanib Concentrations. AAPS J 2024; 26:48. [PMID: 38622446 DOI: 10.1208/s12248-024-00918-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/25/2024] [Indexed: 04/17/2024] Open
Abstract
Pazopanib is a multi-kinase inhibitor used to treat advanced/metastatic renal cell carcinoma and advanced soft tissue tumors; however, side effects such as diarrhea and hypertension have been reported, and dosage adjustment based on drug concentration in the blood is necessary. However, measuring pazopanib concentrations in blood using the existing methods is time-consuming; and current dosage adjustments are made using the results of blood samples taken at the patient's previous hospital visit (approximately a month prior). If the concentration of pazopanib could be measured during the waiting period for a doctor's examination at the hospital (in approximately 30 min), the dosage could be adjusted according to the patient's condition on that day. Therefore, we aimed to develop a method for rapidly measuring blood pazopanib concentrations (in approximately 25 min) using common analytical devices (a tabletop centrifuge and a spectrometer). This method allowed for pazopanib quantification in the therapeutic concentration range (25-50 μg/mL). Additionally, eight popular concomitant medications taken simultaneously with pazopanib did not interfere with the measurements. We used the developed method to measure blood concentration in two patients and obtained similar results to those measured using the previously reported HPLC method. By integrating it with the point of care and sample collection by finger pick, this method can be used for measurements in pharmacies and patients' homes. This method can maximize the therapeutic effects of pazopanib by dose adjustment to control adverse events.
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Affiliation(s)
- Masaru Kato
- Department of Bioanalytical Chemistry, Showa University Graduate School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Shinichi Maruyama
- Department of Bioanalytical Chemistry, Showa University Graduate School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
- Department of Pharmacy, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Noriko Watanabe
- Department of Bioanalytical Chemistry, Showa University Graduate School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Risa Yamada
- Department of Bioanalytical Chemistry, School of Pharmacy, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Yuki Suzaki
- Department of Bioanalytical Chemistry, School of Pharmacy, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Masaru Ishida
- Department of Urology, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Hiroshi Kanno
- Department of Pharmacy, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
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Feng J, Zhou P, Qin C, Chen R, Chen Q, Li L, Chen J, Cheng H, Huang W, Cao J. Magnetic solid-phase extraction-based surface-enhanced Raman spectroscopy for label-free therapeutic drug monitoring of carbamazepine and clozapine in human serum. Spectrochim Acta A Mol Biomol Spectrosc 2024; 310:123924. [PMID: 38262293 DOI: 10.1016/j.saa.2024.123924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/19/2024] [Accepted: 01/19/2024] [Indexed: 01/25/2024]
Abstract
Determination of antiepileptic drugs and antipsychotics in human serum is significant in individualized drug administration and therapeutic drug monitoring (TDM). In this study, we developed a rapid label-free TDM method for the antiepileptic drug carbamazepine (CBZ) and the antipsychotic clozapine (CLO) in human serum. This detection strategy is based on the combination of surface-enhanced Raman scattering (SERS) and magnetic solid-phase extraction (MSPE). Initially, Fe3O4@SiO2@MIL-101(Fe) nanocomposites were synthesized by the layer-by-layer self-assembly method and characterized using scanning electron microscopy, transmission electron microscopy, X-ray diffraction, Brunauer-Emmett-Teller, ultraviolet-visible, and Fourier transform infrared analyses. Subsequently, CBZ and CLO were detected in human serum using Fe3O4@SiO2@MIL-101(Fe) as the solid-phase extraction adsorbent and Ag nanoparticles as SERS substrates. The potential of the MSPE-SERS method for the label-free TDM of CBZ and CLO was then investigated. Fe3O4@SiO2@MIL-101(Fe) prevents magnetic particle aggregation and demonstrates rapid magnetic separation capability that simplifies the pretreatment process and reduces interference from complex matrices. Its large surface area can effectively enrich targets in complex matrices, thereby improving the SERS detection sensitivity. The linearity between CBZ and CLO was excellent over the concentration range of 0.1-100 µg/mL (calculated as the intensity of the SERS characteristic peaks of CBZ and CLO at 728 cm and 1054 cm-1, respectively), with correlation coefficients (R2) of 0.9987 and 0.9957, and detection limits of 0.072 and 0.12 µg/mL, respectively. The recoveries of CBZ with CLO ranged from 94.0 % to 105.0 %, and their relative standard deviations were <6.8 %. Compared to other assays, the developed MSPE-SERS method has the advantages of simple sample pretreatment, rapid detection, and good reproducibility, which provides a novel approach for the TDM of other drugs.
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Affiliation(s)
- Jun Feng
- Department of Medicine, Guangxi University of Science and Technology, Liuzhou 545005, Guangxi, PR China
| | - Pei Zhou
- Guangxi Key Laboratory of Green Processing of Sugar Resources, College of Biological and Chemical Engineering, Guangxi University of Science and Technology, Liuzhou 545006, Guangxi, PR China
| | - Chunli Qin
- Department of Medicine, Guangxi University of Science and Technology, Liuzhou 545005, Guangxi, PR China
| | - Ruijue Chen
- Guangxi Key Laboratory of Green Processing of Sugar Resources, College of Biological and Chemical Engineering, Guangxi University of Science and Technology, Liuzhou 545006, Guangxi, PR China
| | - Qiying Chen
- Guangxi Key Laboratory of Green Processing of Sugar Resources, College of Biological and Chemical Engineering, Guangxi University of Science and Technology, Liuzhou 545006, Guangxi, PR China
| | - Lina Li
- Department of Medicine, Guangxi University of Science and Technology, Liuzhou 545005, Guangxi, PR China
| | - Jun Chen
- Department of Medicine, Guangxi University of Science and Technology, Liuzhou 545005, Guangxi, PR China
| | - Hao Cheng
- Guangxi Key Laboratory of Green Processing of Sugar Resources, College of Biological and Chemical Engineering, Guangxi University of Science and Technology, Liuzhou 545006, Guangxi, PR China
| | - Wenyi Huang
- Guangxi Key Laboratory of Green Processing of Sugar Resources, College of Biological and Chemical Engineering, Guangxi University of Science and Technology, Liuzhou 545006, Guangxi, PR China
| | - Jinru Cao
- Dongguan Key Laboratory of Precision Molecular Diagnostics, Prenatal Diagnosis Center, Dongguan Songshan Lake Central Hospital, Dongguan 523200, Guangdong, PR China.
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Al-Aqbi ZT, Abdulsahib HT, Al-Doghachi FAJ. Micro/nanofluidic device for tamsulosin therapeutic drug monitoring in patients with benign prostatic hyperplasia at point of care. ANAL SCI 2024:10.1007/s44211-024-00533-7. [PMID: 38468109 DOI: 10.1007/s44211-024-00533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/08/2024] [Indexed: 03/13/2024]
Abstract
Discovering the balance between toxicity and efficacy for many drugs requires therapeutic drug monitoring (TDM) of their concentrations in the blood. Here, a hot-embossed microfluidic device with a new design integrated to a nanofracture is presented for purification of blood samples from numerous proteins and cells, allowing to the separation of small molecules from blood matrix. The device was used to separate and quantitatively detect tamsulosin drug after derivatization with fluorescamine reagent, allowing converting it from a neutral molecule into a charged fluorescent complex under the experimental conditions, and thus its separation by electrophoresis. The device is portable and easy operated, and the presented method showed good linearity (R2 = 0.9948) over a concentration range of 0.1-1 μg/mL. The relative standard deviation (RSD%) was below 10% (n = 3), indicating good precisions, and the limit of detection (LOD) and limit of quantitation (LOQ) values were estimated to be 0.1 and 0.55 μg/mL, respectively. Whole blood samples from 10 patients with benign prostatic hyperplasia (BPH) were analyzed, showing good percentage recoveries of tamsulosin in whole blood. This point-of-care (POC), low-cost method could increase the convenience of patients and doctors, make therapies safer, and make TDM available in different regions and places.
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Affiliation(s)
- Zaidon T Al-Aqbi
- Department of Chemistry, Faculty of Science, University of Basrah, Basrah, 61004, Iraq.
- Department of Chemistry, College of Science, University of Misan, Maysan, 62001, Iraq.
| | - Hassan T Abdulsahib
- Department of Chemistry, Faculty of Science, University of Basrah, Basrah, 61004, Iraq
| | - Faris A J Al-Doghachi
- Department of Chemistry, Faculty of Science, University of Basrah, Basrah, 61004, Iraq
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Opitz P, Fobker M, Fabian J, Hempel G. Development and validation of a bioanalytical method for the quantification of methotrexate from serum and capillary blood using volumetric absorptive microsampling (VAMS) and on-line solid phase extraction (SPE) LC-MS. J Chromatogr A 2024; 1715:464610. [PMID: 38157584 DOI: 10.1016/j.chroma.2023.464610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
High-dose methotrexate is part of the polychemotherapy protocols for the treatment of Acute lymphoblastic leukaemia (ALL) with therapeutic drug monitoring (TDM) to adjust leucovorin rescue. An immunoassay is commonly used to analyse serum samples collected via venous blood sampling. However, immunoassays cannot distinguish between the parent drug and its metabolites. Besides, the blood volume required by venous blood sampling is high. Therefore, the aim of this project was to develop a fast, simple, reliable and cost-efficient micro sampling bioanalytical method using capillary blood to minimize the harm of children and to analyse both methotrexate and its metabolites. To achieve this aim, a LC-MS method with on-line solid phase extraction (SPE) for the simultaneous detection of methotrexate and its metabolites from capillary blood using volumetric-absorptive-microsampling (VAMS) technology was developed and fully validated. Besides, the method was also validated and modified for serum samples to compare the results with the immunoassay. A single-quadrupole MS detector was used for detection. Through the use of on-line SPE technology, a lower limit of quantitation of 0.03 µM for MTX and 7-OH-MTX and of 0.05 µM for DAMPA from a 10 μL capillary blood sample was achieved. The accuracy is between 90.0 and 104% and the precision between 4.7 and 12% for methotrexate and its metabolites, respectively. Because of the cross reactivity of the immunoassay a cross-validation was not successful. Besides, a correlation factor of 0.46 for MTX between plasma and whole-blood was found. A fast, simple, reliable and cost-efficient extraction and analysis LC-MS method could be developed and validated, which is applicable in ambulatory and clinical care.
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Affiliation(s)
- Patrick Opitz
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Muenster, Muenster, Germany
| | - Manfred Fobker
- University Hospital Münster - Central facility laboratory, Muenster, Germany
| | - Jörg Fabian
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Muenster, Muenster, Germany
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Muenster, Muenster, Germany.
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Jiang X, Qin Y, Lei R, Han Y, Yang J, Zhang G, Liu J. A rapid and simple HPLC-MS/MS method for the therapeutic drug monitoring of six special-grade antimicrobials in pediatric patients. Heliyon 2024; 10:e24198. [PMID: 38226205 PMCID: PMC10788798 DOI: 10.1016/j.heliyon.2024.e24198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/17/2024] Open
Abstract
Meropenem, linezolid, fluconazole, voriconazole, posaconazole, and vancomycin are six important antimicrobials used for severe infections in critically ill patients listed in special-grade antimicrobials in China. The six antimicrobials' highly variable pharmacodynamics and pharmacokinetics in critically ill pediatric patients present significant challenges to clinicians in ensuring optimal therapeutic targets. Therefore, therapeutic drug monitoring of these antimicrobials in human plasma is necessary to obtain their plasma concentration. A rapid, simple, and sample-saving high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method was developed, which could simultaneously determine all six antimicrobials. It required only 10 μL of plasma and a one-step protein precipitation process. Chromatographic separation was achieved on a reversed-phase column (C18, 30 × 2.1 mm, 2.6 μm) via gradient elution using water and acetonitrile containing 0.1 % formic acid as mobile phase. The injection volume was 2 μL, and the total run time was only 2.5 min. Detection was done using a Triple Quad™ 4500MD tandem mass spectrometer coupled with an electrospray ionization (ESI) source in positive mode. The calibration curves ranged from 0.5 to 64 μg/mL for meropenem and fluconazole, 0.2-25.6 μg/mL for linezolid and voriconazole, 0.1-12.8 μg/mL for posaconazole and 1-128 μg/mL for vancomycin, with the coefficients of correlation all greater than 0.996. Furthermore, the method was validated rigorously according to the European Medicines Agency (EMA) guidelines, demonstrating excellent accuracy (from 93.0 % to 110.6 %) and precision (from 2.0 % to 12.8 %). Moreover, its applicability to various matrices (including serum, hemolytic plasma, and hyperlipidemic plasma) was evaluated. Thus, this method was successfully applied to routine therapeutic drug monitoring for critically ill pediatric patients and other patients in need.
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Affiliation(s)
- Xijuan Jiang
- Department of Pharmacy, Hebei Children's Hospital, Shijiazhuang, Hebei, 050031, China
| | - Yabin Qin
- Department of Pharmacy, Hebei Children's Hospital, Shijiazhuang, Hebei, 050031, China
| | - Rong Lei
- Hebei Key Laboratory of Traditional Chinese Medicine Quality Evaluation and Standard Research, Hebei Institute for Drug and Medical Device Control, Shijiazhuang, Hebei, 050227, China
| | - Yu Han
- Department of Pharmacy, Hebei Children's Hospital, Shijiazhuang, Hebei, 050031, China
| | - Jing Yang
- Department of Pharmacy, Hebei Children's Hospital, Shijiazhuang, Hebei, 050031, China
| | - Guying Zhang
- Department of Pharmacy, Hebei Children's Hospital, Shijiazhuang, Hebei, 050031, China
| | - Jianfang Liu
- Office of Clinical Trial Center, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050017, China
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Aksar A, Lutz J, Wagner E, Strube W, Luykx JJ, Hasan A. Vaccination and clozapine use: a systematic review and an analysis of the VAERS database. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-023-01729-0. [PMID: 38165458 DOI: 10.1007/s00406-023-01729-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
In the context of COVID-19 concerns related to the potential interactions between clozapine and vaccination arose. With the ultimate goal of deriving recommendations for clinical practice, we systematically reviewed the current evidence regarding altered vaccine effectiveness in clozapine-treated patients and safety aspects of vaccination, such as haematological changes and the impact of vaccines on clozapine blood levels, in clozapine-treated patients. A systematic PRISMA-conform literature search of four databases (PubMed, PsycINFO, EMBASE and Cochrane Library) complemented by a case-by-case analysis of the Vaccine Adverse Event Reporting System (VAERS) database was performed. We then systematically appraised the joint evidence and tried to derive recommendations for clinical practice. 14 records were included in this analysis. These records consisted of 5 original articles and 9 case reports. Among the original articles, two studies provided data on the association between clozapine use and antibody responses to vaccination, both indicating that clozapine use in schizophrenia may be associated with reduced levels of immunoglobulins. Additionally, three studies examined vaccine safety in clozapine-treated patients, with no clinically significant adverse effects directly attributable to the interplay between vaccinations and clozapine. VAERS Analysis encompassed 137 reports and showed no consistent evidence of an increased risk for clozapine blood level increases or adverse events. We found no evidence indicating that clozapine impairs the effectiveness of vaccines. Moreover, no serious safety concerns seem to apply when patients on clozapine are receiving vaccines. However, it is crucial to acknowledge that data on the interaction between clozapine and vaccines remain limited.
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Affiliation(s)
- Aslihan Aksar
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Faculty of Medicine, Bezirkskrankenhaus Augsburg, University of Augsburg, Geschwister-Schoenert-Str. 1, 86156, Augsburg, Germany.
| | - Justina Lutz
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Faculty of Medicine, Bezirkskrankenhaus Augsburg, University of Augsburg, Geschwister-Schoenert-Str. 1, 86156, Augsburg, Germany
| | - Elias Wagner
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Faculty of Medicine, Bezirkskrankenhaus Augsburg, University of Augsburg, Geschwister-Schoenert-Str. 1, 86156, Augsburg, Germany
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Wolfgang Strube
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Faculty of Medicine, Bezirkskrankenhaus Augsburg, University of Augsburg, Geschwister-Schoenert-Str. 1, 86156, Augsburg, Germany
| | - Jurjen J Luykx
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Outpatient Second Opinion Clinic, GGNet Mental Health, Warnsveld, The Netherlands
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Faculty of Medicine, Bezirkskrankenhaus Augsburg, University of Augsburg, Geschwister-Schoenert-Str. 1, 86156, Augsburg, Germany
- DZPG (German Center for Mental Health), Partner Site München/Augsburg, Augsburg, Germany
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Tazerouni H, Labbani-Motlagh Z, Amini S, Shahrami B, Sajjadi-Jazi SM, Afhami S, Gholami K, Sadeghi K. Population pharmacokinetics of vancomycin in patients with diabetic foot infection: a comparison of five models. J Diabetes Metab Disord 2023; 22:1385-1390. [PMID: 37975097 PMCID: PMC10638227 DOI: 10.1007/s40200-023-01259-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/01/2023] [Indexed: 11/19/2023]
Abstract
Purpose This study aimed to compare individual pharmacokinetic (PK) parameters of vancomycin with predicted values from five population PK models in patients with diabetic foot infections (DFIs). Methods Patients with a diagnosis of DFI and an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min were included in the study. Individual PK data was carried on by collecting three vancomycin serum concentrations in a steady-state condition. Five published population-based nomograms were assumed to predict PK parameters. Optimal vancomycin exposure was considered as a trough level of 15-20 mg/L or the area under the curve over 24 h/minimum inhibitory concentration (AUC24/MIC) ≥ 400. Results A total of 48 samples from 16 patients were analyzed. There was a statistically significant difference between the volume of distribution (Vd) obtained from population methods and the individual estimations (P ≤ 0.001 in Ambrose and Burton, P = 0.010 and 0.006 in Bauer and Burton revised models, respectively). AUC/MIC ≥ 400 was achieved in 68.7% of patients while 50% had a trough level of less than 15 mg/L. Conclusions Vancomycin PK parameters, particularly individualized Vd, may not be predictable by population nomograms in patients with DFI and stable renal function. Moreover, the weak correlation between AUC24 values and trough concentrations underlines the starting practice of vancomycin AUC24-based monitoring and dosing in the clinical setting.
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Affiliation(s)
- Hedieh Tazerouni
- Department of Clinical Pharmacy, International Campus, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohre Labbani-Motlagh
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahideh Amini
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Shahrami
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Mahmoud Sajjadi-Jazi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Afhami
- Department of Infectious Disease, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kheirollah Gholami
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Kourosh Sadeghi
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Liu T, Gao P, Xie C, Zhang H, Shi Z, Chen R. Study on the daily dose and serum concentration of clozapine in psychiatric patients and possible influencing factors of serum concentration. BMC Psychiatry 2023; 23:596. [PMID: 37582705 PMCID: PMC10428656 DOI: 10.1186/s12888-023-05078-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/02/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Clozapine is the most effective drug for treatment-resistant schizophrenia, and the dosage and concentration of clozapine in the treatment of mental illness vary greatly in different populations and are affected by many factors. METHODS The serum clozapine concentration of 3734 psychiatric patients was detected, and data on daily dose, sex, age and other medical records were collected for statistical analysis. RESULTS The mean daily dose, mean serum concentration and mean C/D (concentration/dose) ratio of clozapine were 191.02 ± 113.47 mg/day, 326.15 ± 235.66 ng/mL and 1.94 ± 1.25 ng/mL per mg/day, respectively. There was difference in daily dose between sexes, and females had higher daily dose (p <0.01), higher serum clozapine concentrations (p < 0.01) and higher C/D ratios (p < 0.01). There were significant differences in daily dose (p < 0.001), serum drug concentration (p < 0.001) and C/D ratio (p < 0.001) among different age groups. The daily dose decreased with age (p for trend < 0.001), and the C/D ratio increased with age (p for trend < 0.001). Inpatients and outpatients had no difference in daily dose, but inpatients had higher serum concentration (p < 0.001) and C/D ratio (p < 0.001). There was no difference in daily dose among different occupations, but there were significant differences in serum concentration (p < 0.001) and C/D ratio (p < 0.001), and unemployed patients may have higher serum concentration and C/D ratio. Duration of disease, comorbidity, marital status, and psychotic type may influence the daily dose and serum concentration. CONCLUSIONS The effective daily dose and serum concentration of clozapine in the study area may be lower than recommended levels, and women have higher serum concentrations and slower metabolic rates. With increasing age, the daily dose decreases, and the metabolic rate slows. Inpatient status and occupation of patients may influence the serum concentration and metabolic rate of clozapine.
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Affiliation(s)
- Taixiu Liu
- Department of Clinical Laboratory, Shandong Daizhuang Hospital, Jining, 272051, China
| | - Peng Gao
- Department of Clinical Laboratory, Shandong Daizhuang Hospital, Jining, 272051, China.
| | - Chuange Xie
- Department of Clinical Laboratory, Shandong Daizhuang Hospital, Jining, 272051, China
| | - Heng Zhang
- Department of Clinical Laboratory, Shandong Daizhuang Hospital, Jining, 272051, China
| | - Zheng Shi
- Department of Clinical Laboratory, Shandong Daizhuang Hospital, Jining, 272051, China
| | - Ruirui Chen
- Department of Clinical Laboratory, Shandong Daizhuang Hospital, Jining, 272051, China
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12
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Liu D, Hu L, Shao H. Therapeutic drug monitoring of immune checkpoint inhibitors: based on their pharmacokinetic properties and biomarkers. Cancer Chemother Pharmacol 2023:10.1007/s00280-023-04541-8. [PMID: 37410155 DOI: 10.1007/s00280-023-04541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/03/2023] [Indexed: 07/07/2023]
Abstract
As a new means of oncology treatment, immune checkpoint inhibitors (ICIs) can improve survival rates in patients with resistant or refractory tumors. However, there are obvious inter-individual differences in the unsatisfactory response rate, drug resistance rate and the occurrence of immune-related adverse events (irAE). These questions have sparked interest in researchers looking for a way to screen sensitive populations and predict efficacy and safety. Therapeutic drug monitoring (TDM) is a way to ensure the safety and effectiveness of medication by measuring the concentration of drugs in body fluids and adjusting the medication regimen. It has the potential to be an adjunctive means of predicting the safety and efficacy of ICIs treatment. In this review, the author outlined the pharmacokinetic (PK) characteristics of ICIs in patients. The feasibility and limitations of TDM of ICIs were discussed by summarizing the relationships between the pharmacokinetic parameters and the efficacy, toxicity and biomarkers.
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Affiliation(s)
- Dongxue Liu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Linlin Hu
- Department of Pharmacy, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Office of Medication Clinical Institution, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hua Shao
- Office of Medication Clinical Institution, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
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13
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Cheng DH, Huang ZG. Therapeutic drug monitoring of disease-modifying antirheumatic drugs in circulating leukocytes in immune-mediated inflammatory diseases. Inflammopharmacology 2023:10.1007/s10787-023-01243-8. [PMID: 37160525 DOI: 10.1007/s10787-023-01243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
The treatment of immune-mediated inflammatory diseases (IMIDs) is one of the main challenges of modern medicine. Although a number of disease-modifying antirheumatic drugs (DMARDs) are available, there is wide variability in clinical response to treatment among individuals. Therapeutic drug monitoring (TDM) has been proposed to optimize treatment; however, some patients still experience unsatisfactory outcomes, although the blood concentrations of drugs in these patients remain in the therapeutic range. One possible reason for this is that the conventional samples (e.g., whole blood or plasma) used in TDM may not accurately reflect drug concentrations or concentrations of their metabolites at the target site. Hence, more refined TDM approaches to guide clinical decisions related to dose optimization are necessary. Circulating leukocytes or white blood cells have a critical role in driving the inflammatory process. They are recruited to the site of injury, infection and inflammation, and the main target of small molecule DMARDs is within immune cells. Given this, assaying drug concentrations in leukocytes has been proposed to be of possible relevance to the interpretation of outcomes. This review focuses on the clinical implications and challenges of drug monitoring of DMARDs in peripheral blood leukocytes from therapeutic or toxicological perspectives in IMIDs.
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Affiliation(s)
- Dao-Hai Cheng
- Department of Pharmacy, First Affiliated Hospital of Guangxi Medical University, Nanning, China.
| | - Zhen-Guang Huang
- Department of Pharmacy, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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14
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Ho WH, Huang TH, Chen YJ, Zeng LY, Liao FF, Liou YC. Prediction of vancomycin initial dosage using artificial intelligence models applying ensemble strategy. BMC Bioinformatics 2023; 22:637. [PMID: 36949378 PMCID: PMC10035120 DOI: 10.1186/s12859-022-05117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/17/2022] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Antibiotic resistance has become a global concern. Vancomycin is known as the last line of antibiotics, but its treatment index is narrow. Therefore, clinical dosing decisions must be made with the utmost care; such decisions are said to be "suitable" only when both "efficacy" and "safety" are considered. This study presents a model, namely the "ensemble strategy model," to predict the suitability of vancomycin regimens. The experimental data consisted of 2141 "suitable" and "unsuitable" patients tagged with a vancomycin regimen, including six diagnostic input attributes (sex, age, weight, serum creatinine, dosing interval, and total daily dose), and the dataset was normalized into a training dataset, a validation dataset, and a test dataset. AdaBoost.M1, Bagging, fastAdaboost, Neyman-Pearson, and Stacking were used for model training. The "ensemble strategy concept" was then used to arrive at the final decision by voting to build a model for predicting the suitability of vancomycin treatment regimens. RESULTS The results of the tenfold cross-validation showed that the average accuracy of the proposed "ensemble strategy model" was 86.51% with a standard deviation of 0.006, and it was robust. In addition, the experimental results of the test dataset revealed that the accuracy, sensitivity, and specificity of the proposed method were 87.54%, 89.25%, and 85.19%, respectively. The accuracy of the five algorithms ranged from 81 to 86%, the sensitivity from 81 to 92%, and the specificity from 77 to 88%. Thus, the experimental results suggest that the model proposed in this study has high accuracy, high sensitivity, and high specificity. CONCLUSIONS The "ensemble strategy model" can be used as a reference for the determination of vancomycin doses in clinical treatment.
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Affiliation(s)
- Wen-Hsien Ho
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, No. 100, Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, No. 100, Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan
- College of Professional Studied, National Pingtung University of Science and Technology, No. 1, Shuefu Road, Pingtung, 912, Taiwan
| | - Tian-Hsiang Huang
- Department of Computer Science and Information Engineering, National Penghu University of Science and Technology, No.300, Liuhe Road, Magong, 880, Penghu, Taiwan
| | - Yenming J Chen
- Department of Information Management, National Kaohsiung University of Science and Technology, No.1, University Road, Kaohsiung, 824, Taiwan
| | - Lang-Yin Zeng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, No. 100, Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan
| | - Fen-Fen Liao
- Department of Pharmacy, Kaohsiung Medical University Hospital, No. 100, Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan.
| | - Yeong-Cheng Liou
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, No. 100, Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, No. 100, Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan.
- Research Center of Nonlinear Analysis and Optimization, Kaohsiung Medical University, No. 100, Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan.
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15
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Zanchetta M, Posocco B, Gagno S, Poetto AS, Orleni M, Canil G, Guardascione M, Puglisi F, Toffoli G. A fast and validated LC-MS/MS method to quantify lenvatinib in dried blood spot. J Pharm Biomed Anal 2023; 226:115255. [PMID: 36682207 DOI: 10.1016/j.jpba.2023.115255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/16/2023]
Abstract
A new LC-MS/MS method for the quantification of lenvatinib (LENVA) in venous Dried Blood Spot (DBS) samples has been presented. This method is characterized by a short run time (4 min), requires a volumetric sampling of 10 µL and extraction of the entire spot to avoid hematocrit (Hct) and spot volume effects. The quantification method was successfully validated in the range of 5.00-2000 ng/mL on two different DBS filter papers (Whatman 31 ET CHR and Whatman 903) according to European Medicines Agency (EMA) and Food and Drug Administration (FDA) guidelines, European Bioanalysis Forum (EBF), and International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT) recommendations. During the validation process, the following parameters were evaluated: recovery (≥ 77% for both filter papers), absence of matrix effect, process efficiency (close to 72% for Whatman 31 ET CHR and close to 77% for Whatman 903), Hct effect (CV ≤ 6.3% and accuracy within 96-112%), linearity (r ≥ 0.998 for Whatman 31 ET CHR and r ≥ 0.999 for Whatman 903), intra- and inter-day precision (CV ≤ 8.8%) and accuracy (92.8-108%), selectivity and sensitivity, reproducibility with incurred samples reanalysis (ISR), and stability. This method was applied to quantify venous DBS samples from patients with hepatocellular carcinoma treated with LENVA enrolled in a cross-validation study (CRO-2018-83). A good correlation between LENVA plasma concentration determined by standard procedure and the new developed DBS LENVA method (R2 ≥ 0.996) has been observed.
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Affiliation(s)
- Martina Zanchetta
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via F. Gallini 2, 33081 Aviano, Italy; Department of Chemical and Pharmaceutical Sciences, University of Trieste, via Licio Giorgieri 1, 34127 Trieste, Italy
| | - Bianca Posocco
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via F. Gallini 2, 33081 Aviano, Italy.
| | - Sara Gagno
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via F. Gallini 2, 33081 Aviano, Italy.
| | - Ariana Soledad Poetto
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via F. Gallini 2, 33081 Aviano, Italy; Doctoral School in Pharmacological Sciences, University of Padua, Lgo Meneghetti 2, 35131 Padova, Italy
| | - Marco Orleni
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via F. Gallini 2, 33081 Aviano, Italy; Doctoral School in Pharmacological Sciences, University of Padua, Lgo Meneghetti 2, 35131 Padova, Italy
| | - Giovanni Canil
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via F. Gallini 2, 33081 Aviano, Italy
| | - Michela Guardascione
- Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via F. Gallini 2, 33081 Aviano, Italy
| | - Fabio Puglisi
- Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via F. Gallini 2, 33081 Aviano, Italy; Department of Medicine (DAME), University of Udine, via Palladio 8, 33100 Udine, Italy
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via F. Gallini 2, 33081 Aviano, Italy
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16
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Chen R, Chen Q, Wang Y, Feng Z, Xu Z, Zhou P, Huang W, Cheng H, Li L, Feng J. Ultrasensitive SERS substrate for label-free therapeutic drug monitoring of chlorpromazine hydrochloride and aminophylline in human serum. Anal Bioanal Chem 2023; 415:1803-1815. [PMID: 36928580 DOI: 10.1007/s00216-023-04621-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
Surface-enhanced Raman spectroscopy (SERS) has been widely used in the field of therapeutic drug monitoring (TDM) because of its powerful fingerprinting capability. In this paper, we used an in situ synthesis method to anchor Ag nanoparticles (AgNPs) on the surface of MIL-101(Cr) to obtain MIL-101(Cr)@Ag. Owing to the large specific surface area and ultra-high porosity of MIL-101(Cr)@Ag, we developed a method for the determination of chlorpromazine hydrochloride (CPZ) and aminophylline (AMP) in human serum by using it as a solid-phase extraction sorbent and SERS substrate. The label-free TDM-SERS method was able to evaluate the levels of CPZ and AMP in serum samples with detection limits as low as 8.91 × 10-2 µg/mL and 3.4 × 10-2 µg/mL, respectively. In addition, influencing factors including sample solution pH, AgNO3 concentration, drug adsorption time, and the amount of sample solution were optimized. This protocol provides a new method with good selectivity, stability, reproducibility, homogeneity, and sensitivity for the determination of small-molecule drug content in serum samples. This label-free TDM-SERS method will help to achieve rapid individualized dosing regimens in clinical practice and has potential applications in the field of TDM.
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Affiliation(s)
- Ruijue Chen
- Guangxi Key Laboratory of Green Processing of Sugar Resources, School of Medicine/College of Biological and Chemical Engineering, Guangxi University of Science and Technology, No. 257 Liushi Road, Yufeng District, Liuzhou City, Guangxi Zhuang Autonomous Region, People's Republic of China.,Provine and Ministry Co-Sponsored Collaborative Innovation Center of Sugarcane and Sugar Industry, Nanning, 530004, Guangxi, People's Republic of China
| | - Qiying Chen
- Guangxi Key Laboratory of Green Processing of Sugar Resources, School of Medicine/College of Biological and Chemical Engineering, Guangxi University of Science and Technology, No. 257 Liushi Road, Yufeng District, Liuzhou City, Guangxi Zhuang Autonomous Region, People's Republic of China.,Provine and Ministry Co-Sponsored Collaborative Innovation Center of Sugarcane and Sugar Industry, Nanning, 530004, Guangxi, People's Republic of China
| | - Ying Wang
- Guangxi Key Laboratory of Green Processing of Sugar Resources, School of Medicine/College of Biological and Chemical Engineering, Guangxi University of Science and Technology, No. 257 Liushi Road, Yufeng District, Liuzhou City, Guangxi Zhuang Autonomous Region, People's Republic of China.,Provine and Ministry Co-Sponsored Collaborative Innovation Center of Sugarcane and Sugar Industry, Nanning, 530004, Guangxi, People's Republic of China
| | - Zhiyang Feng
- KingMed College of Laboratory Medicine, Guangzhou Medical University, Guangzhou, 510182, China
| | - ZiWei Xu
- Guangxi Key Laboratory of Green Processing of Sugar Resources, School of Medicine/College of Biological and Chemical Engineering, Guangxi University of Science and Technology, No. 257 Liushi Road, Yufeng District, Liuzhou City, Guangxi Zhuang Autonomous Region, People's Republic of China.,Provine and Ministry Co-Sponsored Collaborative Innovation Center of Sugarcane and Sugar Industry, Nanning, 530004, Guangxi, People's Republic of China
| | - Pei Zhou
- Guangxi Key Laboratory of Green Processing of Sugar Resources, School of Medicine/College of Biological and Chemical Engineering, Guangxi University of Science and Technology, No. 257 Liushi Road, Yufeng District, Liuzhou City, Guangxi Zhuang Autonomous Region, People's Republic of China.,Provine and Ministry Co-Sponsored Collaborative Innovation Center of Sugarcane and Sugar Industry, Nanning, 530004, Guangxi, People's Republic of China
| | - Wenyi Huang
- Guangxi Key Laboratory of Green Processing of Sugar Resources, School of Medicine/College of Biological and Chemical Engineering, Guangxi University of Science and Technology, No. 257 Liushi Road, Yufeng District, Liuzhou City, Guangxi Zhuang Autonomous Region, People's Republic of China.,Provine and Ministry Co-Sponsored Collaborative Innovation Center of Sugarcane and Sugar Industry, Nanning, 530004, Guangxi, People's Republic of China
| | - Hao Cheng
- Guangxi Key Laboratory of Green Processing of Sugar Resources, School of Medicine/College of Biological and Chemical Engineering, Guangxi University of Science and Technology, No. 257 Liushi Road, Yufeng District, Liuzhou City, Guangxi Zhuang Autonomous Region, People's Republic of China.,Provine and Ministry Co-Sponsored Collaborative Innovation Center of Sugarcane and Sugar Industry, Nanning, 530004, Guangxi, People's Republic of China
| | - Lijun Li
- Guangxi Key Laboratory of Green Processing of Sugar Resources, School of Medicine/College of Biological and Chemical Engineering, Guangxi University of Science and Technology, No. 257 Liushi Road, Yufeng District, Liuzhou City, Guangxi Zhuang Autonomous Region, People's Republic of China. .,Provine and Ministry Co-Sponsored Collaborative Innovation Center of Sugarcane and Sugar Industry, Nanning, 530004, Guangxi, People's Republic of China.
| | - Jun Feng
- Guangxi Key Laboratory of Green Processing of Sugar Resources, School of Medicine/College of Biological and Chemical Engineering, Guangxi University of Science and Technology, No. 257 Liushi Road, Yufeng District, Liuzhou City, Guangxi Zhuang Autonomous Region, People's Republic of China. .,State Key Laboratory for Chemistry and Molecular Engineering of Medicinal Resources, Guangxi Normal University, Guilin, 541004, People's Republic of China.
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Yang S, Zhang YF, Lu SJ, Ye ZQ, Lai JB, Li L, Yang X, Wang DD, Zhang PF, Wu LL, Huang HM, Gao XL, Wu M, Pan YM, Chen YQ, Zhang DH, Geng YM, Zhao QW, Hu SH. Relationship between serum concentration and clinical response of quetiapine in adolescents and adults with bipolar disorders in acute stage: a prospective observational study. J Affect Disord 2023; 324:199-205. [PMID: 36586603 DOI: 10.1016/j.jad.2022.12.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 08/30/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND It is found that there are great differences in the efficacy of quetiapine at the same dose in many patients with bipolar disorders. Therefore, therapeutic drug monitoring (TDM) is a valuable tool for guiding treatment with quetiapine. The aims of this study were to assess the relationship between serum concentration and clinical response of quetiapine in adolescents and adults with bipolar disorders in acute stage. METHODS The study design was prospective and observational. Within the naturalistic setting of a routine TDM service at the First Affiliated Hospital, Zhejiang University School of Medicine. Psychiatric symptoms were assessed using the HAMD (Hamilton Depression Scale), YRMS (Young manic rating scale) and CUDOS-M (Clinically Useful Depression Outcome Scale-Mixed Subscale). The decline of HAMD and YMRS scores was were used to assess clinical outcome of bipolar disorders respectively. RESULTS 169 inpatients (23.7 % male, 76.3 % female) were enrolled in the study. We found that there was a strong correlation between quetiapine serum concentrations and clinical outcomes (rs = 0.702, p < 0.001). While, quetiapine daily dose was not correlated with clinical outcome. We found that when the quetiapine serum level is >146.85 ng/ml in depression episodes patients could obtain a satisfactory treatment effect after 2 weeks of hospitalization. CONCLUSIONS We found a significant positive relationship between serum concentration and clinical outcome, and also determined the serum concentration of quetiapine for the treatment of bipolar depression.
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Affiliation(s)
- Si Yang
- Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
| | - Yan-Fang Zhang
- Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
| | - Shao-Jia Lu
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China; Brain Research Institute of Zhejiang University, Hangzhou 310003, China
| | - Zi-Qi Ye
- Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jian-Bo Lai
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China; Brain Research Institute of Zhejiang University, Hangzhou 310003, China
| | - Lu Li
- Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xi Yang
- Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Dan-Dan Wang
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China; Brain Research Institute of Zhejiang University, Hangzhou 310003, China
| | - Pei-Fen Zhang
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Ling-Ling Wu
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Hui-Min Huang
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xing-Le Gao
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Mian Wu
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yan-Meng Pan
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yi-Qing Chen
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Dan-Hua Zhang
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yi-Meng Geng
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Qing-Wei Zhao
- Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
| | - Shao-Hua Hu
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China; Brain Research Institute of Zhejiang University, Hangzhou 310003, China.
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Zimmermann S, Aghai-Trommeschlaeger F, Kraus S, Grigoleit GU, Gesierich A, Schilling B, Kalogirou C, Goebeler ME, Kurlbaum M, Klinker H, Isberner N, Scherf-Clavel O. Clinical validation and assessment of feasibility of volumetric absorptive microsampling (VAMS) for monitoring of nilotinib, cabozantinib, dabrafenib, trametinib, and ruxolitinib. J Pharm Biomed Anal 2023; 228:115311. [PMID: 36841066 DOI: 10.1016/j.jpba.2023.115311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 02/24/2023]
Abstract
Volumetric absorptive microsampling (VAMS) has emerged as a minimally invasive alternative to conventional sampling. However, the applicability of VAMS must be investigated clinically. Therefore, the feasibility of at-home sampling was investigated for the kinase inhibitors nilotinib, cabozantinib, dabrafenib, trametinib and ruxolitinib and evaluated regarding the acceptance of at-home microsampling, sample quality of at-home VAMS and incurred sample stability. In addition, clinical validation including three different approaches for serum level predictions was performed. For this purpose, VAMS and reference serum samples were collected simultaneously. Conversion of VAMS to serum concentration was based either on a linear regression model, a hematocrit-dependent formula, or using a correction factor. During the study period 591 VAMS were collected from a total of 59 patients. The percentage of patients who agreed to perform VAMS at home ranged from 50.0 % to 84.6 % depending on the compound. 93.1 % of at-home VAMS were collected correctly. Regarding the drug stability in dried capillary blood, no stability issues were detected between on-site and at-home VAMS. Linear regression showed a strong correlation between VAMS and reference serum concentrations for nilotinib, cabozantinib, dabrafenib and ruxolitinib (r 0.9427 - 0.9674) and a moderate correlation for trametinib (r 0.5811). For clinical validation, the acceptance criteria were met for all three approaches for three of the five kinase inhibitors. Predictive performance was not improved by using individual hematocrit instead of population hematocrit and was largely independent of conversion model. In conclusion, VAMS at-home has been shown to be feasible for use in routine clinical care and serum values could be predicted based on the measured VAMS concentration for nilotinib, cabozantinib, and dabrafenib.
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Liu X, Huang C, Bergen PJ, Li J, Zhang J, Chen Y, Chen Y, Guo B, Hu F, Hu J, Hu L, Li X, Qiu H, Shao H, Sun T, Wang Y, Xu P, Yang J, Yang Y, Yu Z, Zhang B, Zhu H, Zuo X, Zhang Y, Miao L, Zhang J. Chinese consensus guidelines for therapeutic drug monitoring of polymyxin B, endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society. J Zhejiang Univ Sci B 2023; 24:130-142. [PMID: 36751699 DOI: 10.1631/jzus.b2200466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Polymyxin B, which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections, became available in China in Dec. 2017. As dose adjustments are based solely on clinical experience of risk toxicity, treatment failure, and emergence of resistance, there is an urgent clinical need to perform therapeutic drug monitoring (TDM) to optimize the use of polymyxin B. It is thus necessary to standardize operating procedures to ensure the accuracy of TDM and provide evidence for their rational use. We report a consensus on TDM guidelines for polymyxin B, as endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society. The consensus panel was composed of clinicians, pharmacists, and microbiologists from different provinces in China and Australia who made recommendations regarding target concentrations, sample collection, reporting, and explanation of TDM results. The guidelines provide the first-ever consensus on conducting TDM of polymyxin B, and are intended to guide optimal clinical use.
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Affiliation(s)
- Xiaofen Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University / Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People's Republic of China / National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Chenrong Huang
- Department of Clinical Pharmacology, the First Affiliated Hospital of Soochow University / Institute for Interdisciplinary Drug Research and Translational Sciences, College of Pharmaceutical Science, Soochow University, Suzhou 215000, China
| | - Phillip J Bergen
- Biomedicine Discovery Institute and Department of Microbiology, Monash University, Melbourne, VIC 3800, Australia
| | - Jian Li
- Biomedicine Discovery Institute and Department of Microbiology, Monash University, Melbourne, VIC 3800, Australia
| | - Jingjing Zhang
- Department of Clinical Pharmacology, the First Affiliated Hospital of Soochow University / Institute for Interdisciplinary Drug Research and Translational Sciences, College of Pharmaceutical Science, Soochow University, Suzhou 215000, China
| | - Yijian Chen
- Institute of Antibiotics, Huashan Hospital, Fudan University / Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People's Republic of China / National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yongchuan Chen
- The Southwest Hospital of Army Medical University, Chongqing 400038, China
| | - Beining Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University / Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People's Republic of China / National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Fupin Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University / Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People's Republic of China / National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jinfang Hu
- The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Linlin Hu
- Zhongda Hospital Southeast University, Nanjing 210009, China
| | - Xin Li
- The Third Hospital of Changsha, Changsha 410035, China
| | - Hongqiang Qiu
- Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Hua Shao
- Zhongda Hospital Southeast University, Nanjing 210009, China
| | - Tongwen Sun
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yu Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University / Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People's Republic of China / National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Ping Xu
- The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Jing Yang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yong Yang
- People's Hospital of Sichuan Province, Chengdu 610072, China
| | - Zhenwei Yu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310020, China
| | - Bikui Zhang
- The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Huaijun Zhu
- Nanjing Drum Tower Hospital, Nanjing 210008, China
| | - Xiaocong Zuo
- The Third Xiangya Hospital of Central South University, Changsha 430100, China
| | - Yi Zhang
- Tianjin First Central Hospital, Tianjin 300190, China
| | - Liyan Miao
- Department of Clinical Pharmacology, the First Affiliated Hospital of Soochow University / Institute for Interdisciplinary Drug Research and Translational Sciences, College of Pharmaceutical Science, Soochow University, Suzhou 215000, China.
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University / Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People's Republic of China / National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China. .,Research Ward of Huashan Hospital, Fudan University, Shanghai 200040, China.
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Sakaguchi Y, Arima R, Maeda R, Obayashi T, Masuda A, Funakoshi M, Tsuchiya Y, Ichikawa N, Inoue K. Development of a useful single-reference HPLC method for therapeutic drug monitoring of phenytoin and carbamazepine in human plasma. ANAL SCI 2023. [PMID: 36637705 DOI: 10.1007/s44211-023-00266-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/29/2022] [Indexed: 01/14/2023]
Abstract
A single reference high-performance liquid chromatographic (SR-HPLC) method was developed and validated for the therapeutic drug monitoring (TDM) of phenytoin (PHT) and carbamazepine (CBZ) in plasma from patients. The analytical parameters evaluated were linearity, limit of quantification (LOQ), selectivity, accuracy, and stability according to the US Food and Drug Administration (FDA) guideline. The developed method shows good linearity (r2 > 0.999; LOQ-50 µg/mL), and LOQ values were 1.56 µg/mL for PHT and 0.40 µg/mL for CBZ at 254 nm. For the development of SR-HPLC method, we evaluated to improve the detection wavelength, stirred retention time, and stability for SR, and selected 5-(p-methylphenyl)-5-phenylhydantoin for PHT (relative molar sensitivity, RMS = 0.848) and 10-methoxyiminostilbene for CBZ (RMS = 0.263). The established differential definite quantities of PHT and CBZ in plasma samples were similar using the RMS and absolute calibration methods based on RSD < 5.10%. A preliminary application was performed using chemiluminescent immunoassay and SR-HPLC method, in which the detectable values of the correlation coefficient and the slope of the intercept were PHT: 0.964 and 0.992647, and CBZ: 0.969 and 1.072089, respectively. Based on these results, we propose that the SR-HPLC method with RMS would be offered to the useful and accurate TDM of various medicines in plasma/serum samples.
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Bernardo M, Mezquida G, Ferré P, Cabrera B, Torra M, Lizana AM, Brunet M. Dried Blood Spot (DBS) as a useful tool to improve clozapine, aripiprazole and paliperidone treatment: From adherence to efficiency. Revista de Psiquiatría y Salud Mental (English Edition) 2022; 15:230-237. [PMID: 36513399 DOI: 10.1016/j.rpsmen.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/18/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Therapeutic Drug Monitoring (TDM) of antipsychotics in schizophrenia is a powerful tool that allows tailoring the treatment in an individualized approach. Our goals are to develop and validate a Dried Blood Spot (DBS) method for monitoring some commonly used antipsychotics (aripiprazole, clozapine, and paliperidone) and to evaluate its usefulness as a compliance biomarker, as well as in drug-dose adjustment to personalize the antipsychotic treatment to improve its efficacy and safety. METHODS 31 first-psychotic episode (FEP) and schizophrenia patients were included; 5 refer to naïve FEP who started antipsychotic treatment; 26, to patients with more than one episode and under antipsychotic treatment: aripiprazole (7 cases), clozapine (17), paliperidone (11). For DBS sample collection, 25μl of capillary blood were placed in the spot of a FTA™DMPK-C-card. After completely dryness, antipsychotics were extracted and analyzed by a validated UHPLC-MS/MS-method. DBS antipsychotic results were compared with those obtained in venous blood/plasma. RESULTS Aripiprazole, paliperidone and clozapine showed from good to excellent correlations between concentrations in venous blood and DBS capillary blood (r2, from 0.500 to 0.721). The correlation between conventional plasma and DBS concentrations for paliperidone, aripiprazole, clozapine, and their metabolites were moderate, suggesting that optimal drug target concentrations should be established for DBS. CONCLUSIONS In this study, for aripiprazole, dehydroaripiprazole, paliperidone, clozapine and desmethylclozapine, DBS has provided good analytical performance for TDM. Thus, DBS sampling can offer a great alternative over conventional sampling for plasma measurement. The assay provides good analytical performances for TDM and clinical research applicability, suggesting that DBS is a promising clinical application in TDM in psychiatry.
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Affiliation(s)
- Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Department of Medicine, University of Barcelona, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute; Department of Basic Clinal Practice, Pharmacology Unit, University of Barcelona, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Paula Ferré
- Pharmacology and Toxicology Laboratoy, SBGM, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Bibiana Cabrera
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Department of Medicine, University of Barcelona, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Mercè Torra
- Pharmacology and Toxicology Laboratoy, SBGM, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ana Maria Lizana
- Pharmacology and Toxicology Laboratoy, SBGM, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Mercè Brunet
- Pharmacology and Toxicology Laboratory, SBGM, Hospital Clínic of Barcelona, Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBEREHD), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain.
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Opitz P, Zimmermann S, Mc Laughlin AM, Müller L, Fuxius S, Illerhaus G, Scherf-Clavel O, Kloft C, Hempel G; ON-TARGET study consortium. Development and validation of a bioanalytical method for the quantification of axitinib from plasma and capillary blood using volumetric absorptive microsampling (VAMS) and on-line solid phase extraction (SPE) LC-MS. J Pharm Biomed Anal 2022; 221:115033. [PMID: 36148722 DOI: 10.1016/j.jpba.2022.115033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 10/31/2022]
Abstract
For therapeutic drug monitoring (TDM) of axitinib, the new volumetric absorption microsampling technology (VAMS™) was applied to obtain capillary blood samples in an ambulatory setting and the results were compared to plasma samples as the gold standard. On-line solid phase extraction (SPE) applying a Turboflow HTLC Cyclone™ 1.0 × 500 mm column was used to reduce costs and working time. For the analytical separation, a Kinetex 2.6 µm C18 100 Å, 100 × 3.0 mm column with a flow rate of 0.3 mL/min in gradient mode was utilised. The mobile phase consisted of acetonitrile, water and formic acid (A: 05:95:0.1 v/v and B: 95:05:0.1 v/v). For the detection, a single-quadrupole MS detector was used. Through the use of on-line SPE technology, it is possible to reach a LLOQ of 0.5 µg/L from a 10 µL capillary blood sample. For lower concentrations, a MS/MS-detector coupled with the same chromatographic system was applied reaching a LLOQ of 0.04 µg/L. This newly developed method was validated with both detectors at different calibration ranges for plasma and capillary blood as matrix. The precision of the within- and between-runs was within a range of 0.6-7.8% and 1.8 - 14% CV, respectively, while the accuracy was within a range of 81.2-115% and 87.7-116%, respectively. A reliable, simple, less personnel-intensive and cost-efficient extraction and analysis LC-MS and LC-MS/MS method could be developed and validated, which is applicable in ambulatory and clinical care.
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Abstract
Reactive therapeutic drug monitoring (TDM) is considered the standard of care for optimizing biologics in inflammatory bowel disease (IBD) including Crohn's disease (CD). Preliminary data show that proactive TDM is associated with positive outcomes in IBD and can be also used to efficiently guide therapeutic decisions in specific clinical scenarios. Higher biological drug concentrations are associated with favorable therapeutic outcomes in specific IBD populations or phenotypes including pediatric CD, perianal fistulizing CD, small bowel CD, and following an ileocolonic resection for CD. Future perspectives of TDM include the use of rapid testing, pharmacogenomics, and pharmacokinetic dashboards toward individualized therapy.
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Affiliation(s)
- Laurie B Grossberg
- Division of Gastroenterology, Center for Inflammatory Bowel Diseases, Beth-Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.
| | - Adam S Cheifetz
- Division of Gastroenterology, Center for Inflammatory Bowel Diseases, Beth-Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Konstantinos Papamichael
- Division of Gastroenterology, Center for Inflammatory Bowel Diseases, Beth-Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
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Lu Q, He X, Fang J, Shi K, Hu F, Bian X, Wang X. Simultaneous determination of linezolid and voriconazole serum concentrations using liquid chromatography-tandem mass spectrometry. J Pharm Biomed Anal 2022; 212:114659. [PMID: 35182831 DOI: 10.1016/j.jpba.2022.114659] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/25/2022]
Abstract
Linezolid and voriconazole are two antimicrobials used for severe infections in critically ill patients. Pharmacokinetics and pharmacodynamics are altered in critically ill patients. Therefore, standard dosing of anti-infective agents may not reach the optimal therapeutic targets. A rapid and simple liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed for simultaneous determination of linezolid and voriconazole in human serum only 3 min after one-step protein precipitation pretreatment to monitor their concentrations. Multiple-reaction monitoring (MRM) mode was used for detection. The calibration curves were linear over the range of 0.5-100 μg/mL for both linezolid and voriconazole, with regression coefficients above 0.9900 for all analytes. The intra- and interday coefficients of variation were below 15% at all concentration levels (LLOQ/LQC/MQC/HQC). This method was successfully applied to routine therapeutic drug monitoring (TDM) for critically ill patients and other patients in need.
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Affiliation(s)
- Qiuya Lu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Xiaoshuang He
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Jie Fang
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Kaifeng Shi
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Fengmei Hu
- Shanghai AB Sciex Analytical Instrument Trading Co., Ltd., Shanghai 200050, China
| | - Xiaolan Bian
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
| | - Xuefeng Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
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Chiu HH, Tsai YJ, Lo C, Lin CH, Tsai IL, Kuo CH. Development of an efficient mAb quantification assay by LC-MS/MS using rapid on-bead digestion. Anal Chim Acta 2022; 1193:339319. [PMID: 35058007 DOI: 10.1016/j.aca.2021.339319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/01/2022]
Abstract
The use of monoclonal antibody (mAb) therapeutics is increasing rapidly, but mAb concentrations vary widely between individuals and might subsequently affect mAb exposure and treatment response. Precision medicine has gained much attention in recent years, but little is known about the personalized dosage of mAb therapeutics. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) has been demonstrated as a selective and sensitive approach to quantify mAb therapeutics in biological samples, but current methods to quantify mAbs are usually time-consuming and require tedious sample preparation. This study developed an efficient LC-MS/MS method using an on-bead trypsin digestion procedure at a higher digestion temperature. Five mAbs, bevacizumab, evolocumab, nivolumab, pembrolizumab, and trastuzumab, used for treating different diseases, were selected for method development. Tocilizumab was selected as the internal standard. The result of the on-bead digestion protocol was compared to the conventional low-pH elution method, and it showed better sensitivity and reproducibility for most mAbs. The optimized on-bead digestion protocol used 75 μL of digestion buffer at 60 °C for a 60 min digestion. The calibration curve was generated from 10 to 200 μg mL-1. The accuracies at the three QC levels of the 5 mAbs were all within 94.5 ± 5.2% to 111.6 ± 3.7%. The repeatability and intermediate precision of the 5 mAbs were all lower than 6.1 and 9.5% RSD, respectively. The newly developed method was successfully applied to quantify trastuzumab in six breast cancer patients under different treatment cycles, and the concentrations ranged from 66.4 to 173.2 μg mL-1. In conclusion, the developed method is more efficient and more practical for real-world analysis of a large number of clinical samples, it could be used for routine therapeutic drug monitoring, and it could contribute to personalized mAb treatment.
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Affiliation(s)
- Huai-Hsuan Chiu
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
| | - Yun-Jung Tsai
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
| | - Chiao Lo
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Hung Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Oncology, National Taiwan University Cancer Center Hospital, Taipei, Taiwan
| | - I-Lin Tsai
- Department of Biochemistry and Molecular Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Ching-Hua Kuo
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
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Kantasiripitak W, Wang Z, Spriet I, Ferrante M, Dreesen E. Recent advancements in clearance monitoring of monoclonal antibodies in patients with inflammatory bowel diseases. Expert Rev Clin Pharmacol 2022; 14:1455-1466. [PMID: 35034509 DOI: 10.1080/17512433.2021.2028619] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Less than 50% of patients with inflammatory bowel diseases (IBD) receiving monoclonal antibody (mAb) therapy achieve endoscopic remission. Poor outcomes may indicate a need for dose optimization. During therapeutic drug monitoring (TDM), drug concentrations are measured, and when found too low, dosage regimen escalations are performed. To date, benefits of TDM of mAbs in patients with IBD are uncertain. AREAS COVERED This review presents an overview of what clearance monitoring is, how it can be performed, and why and when it may be valuable in treating patients with IBD. Virtual patients were used for illustration. A literature search was performed to summarize current evidence for clearance monitoring in IBD and other disease settings. EXPERT OPINION During clearance monitoring, mAb clearance is calculated and monitored over time. Higher mAb clearance in patients with IBD has been associated with higher target load (target-mediated drug disposition), protein-losing enteropathy (fecal drug loss), and immunogenicity. Although not prospectively confirmed, clearance monitoring might facilitate identification of (yet) asymptomatic disease flares or presence of (yet) undetectable anti-drug antibodies. Furthermore, clearance monitoring may be used to predict treatment outcomes. Whether dosage regimen adjustments can modify the clearance time course and the treatment outcome is to be determined.
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Affiliation(s)
- Wannee Kantasiripitak
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Zhigang Wang
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Department of Pharmacy, University Hospitals Leuven, Leuven, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, University of Leuven, Leuven, Belgium
| | - Erwin Dreesen
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Schoretsanitis G, Haen E, Piacentino D, Conca A, Endres K, Hiemke C, Gründer G, Paulzen M. Clinical response in patients treated with once-monthly paliperidone palmitate: analysis of a therapeutic drug monitoring (TDM) database. Eur Arch Psychiatry Clin Neurosci 2021; 271:1437-1443. [PMID: 33821323 DOI: 10.1007/s00406-021-01257-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/30/2021] [Indexed: 12/01/2022]
Abstract
To investigate pharmacokinetic correlates of clinical response in patients treated with once-monthly paliperidone palmitate (PP1M) injections at steady state. Plasma concentrations and dose-adjusted-plasma concentrations (C/D) of paliperidone from a naturalistic therapeutic drug monitoring (TDM) database were compared between responders and non-responders using the Clinical Global Impressions-Improvement scale (CGI-I) ratings. Analyses were based on the non-parametric Mann-Whitney U test and the Pearson Chi-squared test (χ2) with a significance level of 0.05. Subgroup analyses were performed separately in patients with schizophrenia spectrum, schizoaffective disorders and bipolar disorders. Comparing 93 responders with 80 non-responders, we detected no significant differences in the proportion of females, age, and body mass index (p's ranging 0.18-0.83); there were more smokers in the group of non-responders (p = 0.04), which also included more patients with bipolar disorders (p = 0.014). Despite the lack of differences for prescribed PP1M doses and dose intervals (p = 0.42 and p = 0.11, respectively), non-responders had higher paliperidone plasma concentrations and C/D levels (p = 0.033 and p = 0.021, respectively). Subgroup analyses did not yield differences for paliperidone plasma and C/D levels between non-responders and responders with schizophrenia spectrum (p = 0.099 and p = 0.14, respectively) and bipolar disorders (p = 0.95 and p = 0.75, respectively); dose-adjusted plasma concentrations were higher in non-responders compared to responders with schizoaffective disorders (p = 0.039), while no differences were reported for plasma levels (p = 0. 15). Our results show that paliperidone plasma concentrations over injection doses may be associated with patterns of clinical response suggesting potential utility of TDM as part of PP1M-based maintenance treatment.
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Affiliation(s)
- Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Behavioral Health Pavilion, 7559 263rd Street, Glen Oaks, NY, 11004, USA.
| | - Ekkehard Haen
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Daria Piacentino
- Psychiatric Service of the Health District of Bozen, Bozen, Italy.,Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, National Institute On Drug Abuse Intramural Research Program and National Institute On Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, The National Institutes of Health, Bethesda, MD, USA
| | - Andreas Conca
- Psychiatric Service of the Health District of Bozen, Bozen, Italy
| | - Katharina Endres
- Clinical Pharmacology, Department of Psychiatry and Psychotherapy and Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA-Translational Brain Medicine, Aachen, Germany
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Brasso C, Cisotto M, Ghirardini C, Pennazio F, Villari V, Rocca P. Accuracy of self-reported adherence and therapeutic drug monitoring in a psychiatric emergency ward. Psychiatry Res 2021; 305:114214. [PMID: 34587569 DOI: 10.1016/j.psychres.2021.114214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
The aims of the study were: (1) the evaluation of the agreement between therapeutic drug monitoring (TDM) and a self-assessment of adherence to psychopharmacological treatments; (2) the identification of predictors of TDM results.Adherence in patients admitted into a psychiatric emergency service (PES) for a relapse of a schizophrenia spectrum disorder (SSD) or a bipolar disorder (BD; DSM-5) was assessed both directly with TDM and indirectly with a self-reported measure (Medication Adherence Report Scale -MARS- 10 items). The agreement between TDM and MARS was evaluated. Fifty-seven patients with SSD and 76 people with BD participated in the study. TDM was in range in about 50% of the global sample. No evidence of an association between MARS total scores and TDM results was found. Sensitivity, specificity, positive and negative predictive values of almost all MARS total scores were near to 50%. Smoking was strongly associated with a reduction of TDM results within the reference range. In the BD group, female sex was a predictor of TDM in range. In this clinical setting, self-assessment of adherence is neither reliable nor predictive. Furthermore, smoking is a strong predictor of poor adherence to psychopharmacological therapy.
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Affiliation(s)
- Claudio Brasso
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, Turin 10126, Italy.
| | - Marta Cisotto
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, Turin 10126, Italy; Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy
| | - Camilla Ghirardini
- Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy
| | - Filippo Pennazio
- Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy
| | - Vincenzo Villari
- Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy.
| | - Paola Rocca
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, Turin 10126, Italy.
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Verougstraete N, Stove V, Verstraete AG, Stove C. Quantification of eight hematological tyrosine kinase inhibitors in both plasma and whole blood by a validated LC-MS/MS method. Talanta 2021; 226:122140. [PMID: 33676691 DOI: 10.1016/j.talanta.2021.122140] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 01/18/2023]
Abstract
Therapeutic drug monitoring (TDM) of tyrosine kinase inhibitors (TKIs) in cancer therapy offers the potential to improve treatment efficacy while minimizing toxicity. Therefore, a high-throughput, sensitive LC-MS/MS method was developed and validated, to be used for personalized treatment of hematologic malignancies. The assay allows the simultaneous quantification in plasma (EDTA and heparin) and whole blood of eight TKIs, including bosutinib, dasatinib, gilteritinib, ibrutinib, imatinib, midostaurin, nilotinib and ponatinib, which are used in the treatment of chronic and acute myeloid leukemia (CML, AML) and chronic lymphocytic leukemia (CLL). The procedure involves simple protein precipitation of 50 μL of sample, a 4-min chromatographic separation by applying gradient elution on a standard reverse phase column, and tandem mass spectrometric detection. The method was successfully validated based on international guidelines in terms of calibration curves, precision (within-run CV 0.74-16.4%; between-run CV 1.65-17.8%), accuracy (within-run bias 0.07-19.8%; between-run bias 0.05 to -17.6%), carry-over (max 19.4%, for ponatinib), selectivity, matrix-effects, recovery (ranging from 61 to 128%), stability (only issues observed for ibrutinib) and dilution integrity. Furthermore, the accuracy of the method was demonstrated by analyzing external quality controls, with a maximum bias of -11.3%. Assay applicability was demonstrated by analyzing authentic plasma and whole blood samples in order to derive blood-plasma ratios and the variation thereof. The latter are important to allow possible blood-plasma conversion when envisaging possible future implementation of TDM via dried blood microsampling. The presented method can be applied in clinical practice for performing TDM of TKIs in plasma and whole blood samples.
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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
| | - Alain G Verstraete
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Christophe Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
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Rakete S, Schuster C, Paal M, Vogeser M. An isotope-dilution LC-MS/MS method for the simultaneous quantification of meropenem and its open-ring metabolite in serum. J Pharm Biomed Anal 2021; 197:113944. [PMID: 33588299 DOI: 10.1016/j.jpba.2021.113944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/22/2021] [Accepted: 01/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) of beta-lactam antibiotics and, among them, especially meropenem gains importance in the field of laboratory medicine. Meropenem is known to be unstable, resulting in a degradation product with an open beta-lactam ring. For a more comprehensive TDM of meropenem, the aim was to develop a LC-MS/MS method for the simultaneous quantification of meropenem and its main degradation product, the open-ring metabolite (ORM). METHODS The method involves a protein precipitation followed by chromatographic separation using a formic acid-ammonium formate methanol gradient on a pentafluorophenyl column. Multiple reaction monitoring in the positive ion mode and stable isotope labeled internal standards were used for quantification. Validation was performed according to the European Medicines Agency guideline. RESULTS Validation was successful performed within the linear drug concentration range of 1.0-100.0 mg/l for meropenem and 0.62-62.30 mg/l for the ORM. Investigation of selectivity, accuracy and precision showed good results and potential matrix effects were successfully compensated by the internal standards. The suitability of the method was shown by the comparison of 35 anonymized leftover serum samples from intensive care patients with routine analyses. CONCLUSION For the first time, we herein describe a liquid chromatography tandem mass spectrometry (LC-MS/MS) method for the simultaneous quantification of meropenem and its ORM in human serum. The ratio of active to inactive compound provides valuable pharmaceutical and pharmacokinetic information, which may contribute to therapeutic efficacy.
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Affiliation(s)
- Sophie Rakete
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany.
| | - Carina Schuster
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Michael Paal
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Michael Vogeser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
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Al-Balawi RS, Alshehri MA, Alatawi AS, Al Shehri AM, Alshehry MA, Al-Gayyar MMH. Measuring the appropriateness of carbamazepine and valproic acid prescribing and utilization using a newly implemented online system in the Tabuk Region of Saudi Arabia. Saudi Pharm J 2020; 28:844-849. [PMID: 32647486 PMCID: PMC7335707 DOI: 10.1016/j.jsps.2020.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/12/2020] [Indexed: 11/27/2022] Open
Abstract
Epilepsy is a common neurologic disorder, which is efficiently treated with carbamazepine and valproic acid. Moreover, Saudi Ministry of Health implemented a new E-system for Poison Control Centers called Awtar to enhance technology utilization in ensuring patients’ satisfaction and to improve treatment outcomes. Therefore, we conducted this study to assess appropriateness of indication of requests and therapeutic levels of carbamazepine and valproic acid in Tabuk area, North West Saudi Arabia. This is a retrospective observational study conducted in Poison Control & Forensic Chemistry Center, Tabuk, Saudi Arabia. Patients’ data were obtained for years 2018 and 2019. The blood levels of carbamazepine and valproic acid were measured by Therapeutic Drug Monitoring (TDM) Unit. We selected patients treated with either valproic acid or carbamazepine alone without any history of drug allergy. Data of 264 patients were extracted from Awtar E-system. Serum carbamazepine levels were within therapeutic range in 114 patients (75.50%), above-therapeutic range in 13 patients (8.61%) and sub-therapeutic levels in 24 patients (15.89%). Regarding serum valproic acid, it is within therapeutic range in 62 patients (54.87%), above-therapeutic range in 11 patients (9.73%) and sub-therapeutic levels in 40 patients (35.40%). In conclusion, this study gives information about partial appropriateness of usage of carbamazepine and low level of appropriateness of valproic acid. However, more efforts are needed to improve results of appropriateness of indication of antiepileptic drugs.
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Affiliation(s)
- Reem S Al-Balawi
- PharmD Program, Faculty of Pharmacy, University of Tabuk, Saudi Arabia
| | | | - Abdullah S Alatawi
- Poison Control & Medical Forensic Chemistry Centers, Tabuk, Saudi Arabia
| | - Abdullah M Al Shehri
- Clinical Health Education, Public Health Department of Health Affairs, Tabuk Region, Saudi Arabia
| | | | - Mohammed M H Al-Gayyar
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Tabuk, Saudi Arabia.,Department of Biochemistry, Faculty of Pharmacy, Mansoura University, Egypt
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Zeng M, Yi Q, Zeng L, Chen Z, Mi X, Song H, Zhang X, Li Y, Wang Q, Zhao R, Miao L, Zhang L. Quality of therapeutic drug monitoring guidelines is suboptimal: an evaluation using the Appraisal of Guidelines for Research and Evaluation II instrument. J Clin Epidemiol 2019; 120:47-58. [PMID: 31678686 DOI: 10.1016/j.jclinepi.2019.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/05/2019] [Accepted: 10/29/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Although therapeutic drug monitoring (TDM) guidelines are available, systematic evaluations of their methodological quality are scarce. This study aimed to assess the quality of current TDM guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. STUDY DESIGN AND SETTING We performed a systematic search to identify the relevant TDM guidelines in PubMed, EMBASE, CNKI, Wan Fang Database, CBM, VIP, four main guideline databases (NICE, NGC, GIN, and WHO guideline databases), and official websites of the governments and societies associated with TDM from the inception date to May 2018. Four independent appraisers rated the quality of each TDM guideline using the AGREE II instrument, and the mean score of each AGREE II item was calculated. The overall agreement among the appraisers was evaluated using the intraclass correlation coefficient (ICC). RESULTS Twenty-eight TDM guidelines satisfied the eligibility criteria from among 12,235 references. The overall agreement among the appraisers was substantial (0.700-0.880). The mean scores for the six AGREE II domains were scope and purpose, 67.7% (95% CI, 64.0-71.4%); stakeholder involvement, 39.8% (95% CI, 33.3-46.3%); rigor of development, 36.0% (95% CI, 28.1-43.9%); clarity and presentation, 61.6% (95% CI, 55.7-67.4%); applicability, 30.6% (95% CI, 26.4-34.8%); and editorial independence, 49.2% (95% CI, 40.0-58.6%). The reviewers recommended only four guidelines, and most of the TDM guidelines were rated as "recommended with modifications." CONCLUSION Overall, the quality of TDM guidelines is suboptimal according to the evaluation using the AGREE II instrument. The domains of applicability, rigor of development, stakeholder involvement, and editorial independence of the guidelines need to be reported. In addition, guideline developers closely adhering to the AGREE II instrument and the Grading of Recommendations Assessment Development and Evaluation system are required to draft high-quality and reliable TDM guidelines.
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Affiliation(s)
- Min Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China; West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Qiusha Yi
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China; West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
| | - Zhe Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
| | - Xue Mi
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
| | - Haoxin Song
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China; West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Xianglin Zhang
- Pharmaceutical Department, China-Japan Friendship Hospital, Beijing, China
| | - Youping Li
- Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wang
- Department of Standardization, National Center for Medical Service Administration, National Health Commission of the People's Republic of China, Beijing, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Liyan Miao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China.
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Cruz AT, Starke JR. Monitoring Treatment of Childhood Tuberculosis and the Role of Therapeutic Drug Monitoring. Indian J Pediatr 2019; 86:732-9. [PMID: 30815840 DOI: 10.1007/s12098-019-02882-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
Most children tolerate the first-line antibiotics used to treat Mycobacterium tuberculosis (TB) very well. The most common adverse effect is gastrointestinal distress unrelated to hepatotoxicity; the latter is seen in less than 1% of children. Despite the infrequency of hepatotoxicity, the potential long-term impact of hepatic insufficiency dictates that all children receiving antimycobacterial therapy should be evaluated periodically by symptom screening and physical examination. Routine measurement of transaminases in previously healthy, asymptomatic children is discouraged, as up to 40% of children will have transient, asymptomatic transaminase elevation that should not alter clinical management; measurement of serum liver enzymes is reserved for children who develop symptoms and those with existing liver disease or taking other potentially hepatotoxic drugs. Caregivers and personnel distributing directly-observed therapy need to be cognizant of potential drug toxicities and have a clear understanding of what to do if a child develops symptoms. There are substantial inter-patient variations in serum antibiotic concentrations when the same milligram per kilogram dose is given to different children of varying ages and sizes, reflecting differences in drug absorption and metabolism. While these variations may not impact the outcome of previously healthy children with mild disease, outcomes for children with human immunodeficiency virus infection or severe disease can be worse if sub-therapeutic drug concentrations are achieved. Therapeutic drug monitoring, wherein serum drug concentrations are used to optimize medication doses, should be considered for children with severe disease or if there is concern about alterations in drug absorption or metabolism.
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Hagel S, Fiedler S, Hohn A, Brinkmann A, Frey OR, Hoyer H, Schlattmann P, Kiehntopf M, Roberts JA, Pletz MW. Therapeutic drug monitoring-based dose optimisation of piperacillin/tazobactam to improve outcome in patients with sepsis (TARGET): a prospective, multi-centre, randomised controlled trial. Trials 2019; 20:330. [PMID: 31171029 PMCID: PMC6554958 DOI: 10.1186/s13063-019-3437-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 05/10/2019] [Indexed: 12/25/2022] Open
Abstract
Background Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection with a hospital mortality in excess of 40%. Along with insufficient and delayed empirical antimicrobial therapy, inappropriate antimicrobial exposure has been identified to negatively affect patient outcomes. Receipt of prolonged infusion (i.e. extended or continuous infusion) of piperacillin/tazobactam (TZP) improves antimicrobial exposure and is associated with reduced mortality in patients with sepsis. Using therapeutic drug monitoring (TDM) with dosing tailored to the altered pharmacokinetics of the individual patient to avoid under- and overdosing may be a further strategy to improve patient outcomes. This current trial will address the question whether a TDM-guided therapy with TZP administered by continuous infusion will result in a greater resolution of organ dysfunction and hence better clinical outcome compared to continuous infusion of the total daily dose of TZP without TDM. Methods The study is an investigator-initiated, multi-centre, parallel-group, single-blinded, randomised controlled trial. The trial will be conducted in several centres across Germany. Adult patients (aged ≥ 18 years) with severe sepsis or septic shock will be eligible for study participation. Participants will be randomly assigned to receive either TZP by continuous infusion guided by daily TDM of piperacillin (experimental group) or by continuous infusion without TDM guidance (total daily dose in normal renal function 13.5 g TZP) (control group). The pharmacokinetic (PK)/pharmacodynamic (PD) target will be 100% f T>4MIC (percentage of time during a dosing interval that the free [f] drug concentration exceeds 4 times the minimum inhibitory concentration). The primary efficacy endpoint is the change in mean total Sequential Organ Failure Assessment score from day 1 after randomisation until day 10 or discharge from the intensive care unit or death, whichever comes first. Secondary outcomes include mortality, clinical cure, microbiological cure, overall antibiotic use, individual components of the primary outcome, adverse events and analysis of PK and (PD) indices. Discussion This trial will assess for the first time whether continuous infusion of TZP guided by daily TDM in patients with sepsis will result in a greater resolution of organ dysfunction and hence better clinical outcome compared to continuous infusion without TDM. Trial registration German Clinical Trials Register (GermanCTR), DRKS00011159. Registered on 10 October 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3437-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany. .,Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.
| | - Sandra Fiedler
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Andreas Hohn
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Alexander Brinkmann
- Department of Anaesthesiology and Intensive Care Medicine, General Hospital of Heidenheim, Heidenheim, Germany
| | - Otto R Frey
- Department of Pharmacy, General Hospital of Heidenheim, Heidenheim, Germany
| | - Heike Hoyer
- Institute of Medical Statistics, Computer Sciences and Data Sciences, Jena University Hospital, Jena, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Sciences, Jena University Hospital, Jena, Germany
| | - Michael Kiehntopf
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.,Department of Clinical Chemistry and Laboratory Medicine, Jena University Hospital, Jena, Germany.,Integrated Biobank Jena (IBBJ), Jena University Hospital, Jena, Germany
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, and School of Pharmacy, University of Queensland, Brisbane, Australia.,Department of Intensive Care Medicine and Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
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Schijvens AM, van Hesteren FHS, Cornelissen EAM, Bootsma-Robroeks CMHHT, Brüggemann RJM, Burger DM, de Wildt SN, Schreuder MF, Ter Heine R. The potential impact of hematocrit correction on evaluation of tacrolimus target exposure in pediatric kidney transplant patients. Pediatr Nephrol 2019; 34:507-15. [PMID: 30374607 DOI: 10.1007/s00467-018-4117-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tacrolimus is an important immunosuppressive agent with high intra- and inter-individual pharmacokinetic variability and a narrow therapeutic index. As tacrolimus extensively accumulates in erythrocytes, hematocrit is a key factor in the interpretation of tacrolimus whole blood concentrations. However, as hematocrit values in pediatric kidney transplant patients are highly variable after kidney transplantation, translating whole blood concentration targets without taking hematocrit into consideration is theoretically incorrect. The aim of this study is to evaluate the potential impact of hematocrit correction on tacrolimus target exposure in pediatric kidney transplant patients. METHODS Data were obtained from 36 pediatric kidney transplant patients. Two hundred fifty-five tacrolimus whole blood samples were available, together responsible for 36 area under the concentration-time curves (AUCs) and trough concentrations. First, hematocrit corrected concentrations were derived using a formula describing the relationship between whole blood concentrations, hematocrit, and plasma concentrations. Subsequently, target exposure was evaluated using the converted plasma target concentrations. Ultimately, differences in interpretation of target exposure were identified and evaluated. RESULTS In total, 92% of our patients had lower hematocrit (median 0.29) than the reference value of adult kidney transplant patients. A different evaluation of target exposure for either trough level, AUC, or both was defined in 42% of our patients, when applying hematocrit corrected concentrations. CONCLUSION A critical role for hematocrit in therapeutic drug monitoring of tacrolimus in pediatric kidney transplant patients is suggested in this study. Therefore, we believe that hematocrit correction could be a step towards improvement of tacrolimus dose individualization.
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Dilena R, DiFrancesco JC, Soldovieri MV, Giacobbe A, Ambrosino P, Mosca I, Galli MA, Guez S, Fumagalli M, Miceli F, Cattaneo D, Darra F, Gennaro E, Zara F, Striano P, Castellotti B, Gellera C, Varesio C, Veggiotti P, Taglialatela M. Early Treatment with Quinidine in 2 Patients with Epilepsy of Infancy with Migrating Focal Seizures (EIMFS) Due to Gain-of-Function KCNT1 Mutations: Functional Studies, Clinical Responses, and Critical Issues for Personalized Therapy. Neurotherapeutics 2018; 15:1112-1126. [PMID: 30112700 PMCID: PMC6277296 DOI: 10.1007/s13311-018-0657-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Epilepsy of infancy with migrating focal seizures (EIMFS) is a rare early-onset developmental epileptic encephalopathy resistant to anti-epileptic drugs. The most common cause for EIMFS is a gain-of-function mutation in the KCNT1 potassium channel gene, and treatment with the KCNT1 blocker quinidine has been suggested as a rational approach for seizure control in EIMFS patients. However, variable results on the clinical efficacy of quinidine have been reported. In the present study, we provide a detailed description of the clinical, genetic, in vitro, and in vivo electrophysiological profile and pharmacological responses to quinidine of 2 EIMFS unrelated patients with a heterozygous de novo KCNT1 mutation: c.2849G>A (p.R950Q) in patient 1 and c.2677G>A (p.E893K) in patient 2. When expressed heterologously in CHO cells, KCNT1 channels carrying each variant showed gain-of-function effects, and were more effectively blocked by quinidine when compared to wild-type KCNT1 channels. On the basis of these in vitro results, add-on quinidine treatment was started at 3 and 16 months of age in patients 1 and 2, respectively. The results obtained reveal that quinidine significantly reduced seizure burden (by about 90%) and improved quality of life in both patients, but failed to normalize developmental milestones, which persisted as severely delayed. Based on the present experience, early quinidine intervention associated with heart monitoring and control of blood levels is among the critical factors for therapy effectiveness in EIMFS patients with KCNT1 gain-of-function mutations. Multicenter studies are needed to establish a consensus protocol for patient recruitment, quinidine treatment modalities, and outcome evaluation, to optimize clinical efficacy and reduce risks as well as variability associated to quinidine use in such severe developmental encephalopathy.
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Affiliation(s)
- Robertino Dilena
- Pediatric Epileptology and Neurophysiology (RD), Infantile Neuropsichiatry (AG), Cardiology (MAG), High Intensity Pediatric Care (SG), Neonatology (MF), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Jacopo C DiFrancesco
- Clinical Neurophysiology and Epilepsy Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
- Department of Neurology, San Gerardo Hospital, School of Medicine and Surgery, Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, 20900, Monza, Italy
| | | | - Antonella Giacobbe
- Pediatric Epileptology and Neurophysiology (RD), Infantile Neuropsichiatry (AG), Cardiology (MAG), High Intensity Pediatric Care (SG), Neonatology (MF), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Paolo Ambrosino
- Department of Medicine and Health Science, University of Molise, 86100, Campobasso, Italy
| | - Ilaria Mosca
- Department of Medicine and Health Science, University of Molise, 86100, Campobasso, Italy
| | - Maria Albina Galli
- Pediatric Epileptology and Neurophysiology (RD), Infantile Neuropsichiatry (AG), Cardiology (MAG), High Intensity Pediatric Care (SG), Neonatology (MF), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Sophie Guez
- Pediatric Epileptology and Neurophysiology (RD), Infantile Neuropsichiatry (AG), Cardiology (MAG), High Intensity Pediatric Care (SG), Neonatology (MF), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Monica Fumagalli
- Pediatric Epileptology and Neurophysiology (RD), Infantile Neuropsichiatry (AG), Cardiology (MAG), High Intensity Pediatric Care (SG), Neonatology (MF), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Francesco Miceli
- Division of Pharmacology, Department of Neuroscience, University of Naples "Federico II", 80131, Naples, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, 20157, Milan, Italy
| | - Francesca Darra
- Department of Surgical, Odontostomatological, and Maternal-Infantile Sciences, University of Verona, 37134, Verona, Italy
| | - Elena Gennaro
- Laboratory of Genetics, E.O. Ospedali Galliera, 16128, Genoa, Italy
| | - Federico Zara
- Laboratory of Genetics, E.O. Ospedali Galliera, 16128, Genoa, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, 16147, Genoa, Italy
| | - Barbara Castellotti
- Unit of Genetics of Neurodegenerative and Metabolic Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Cinzia Gellera
- Unit of Genetics of Neurodegenerative and Metabolic Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, "C. Mondino" National Neurological Institute, 27100, Pavia, Italy
| | - Pierangelo Veggiotti
- Department of Biomedical and Clinical Sciences, Children's Hospital Vittore Buzzi, University of Milan, and Pediatric Neurology, 20154, Milan, Italy
| | - Maurizio Taglialatela
- Department of Medicine and Health Science, University of Molise, 86100, Campobasso, Italy.
- Division of Pharmacology, Department of Neuroscience, University of Naples "Federico II", 80131, Naples, Italy.
- Department of Neuroscience, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy.
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Paal M, Zoller M, Schuster C, Vogeser M, Schütze G. Simultaneous quantification of cefepime, meropenem, ciprofloxacin, moxifloxacin, linezolid and piperacillin in human serum using an isotope-dilution HPLC-MS/MS method. J Pharm Biomed Anal 2018; 152:102-10. [PMID: 29414000 DOI: 10.1016/j.jpba.2018.01.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 01/08/2023]
Abstract
The aim of the current study was to develop and validate a robust multi-analyte high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS) method for simultaneous quantification of cefepime, meropenem, ciprofloxacin, moxifloxacin, linezolid and piperacillin, which are the most commonly used antibiotics in intensive care units. Sample clean-up included a protein precipitation protocol, followed by chromatographic separation on a C8 reverse phase HPLC column within 4 min, using a formic acid-ammonium formiate methanol step-elution gradient. All compounds were detected with electrospray ionization (ESI+) mass spectrometry in multiple reaction time monitoring. The method was validated according to the protocol from the European Medicines Agency and was thoroughly evaluated for interferences and quantification linearity. Linear relationships between peak area responses and drug concentrations were obtained in the range of 0.25-200 mg/l for cefepime, 0.25-120 mg/l for meropenem, 0.05-10 mg/l for ciprofloxacin, 0.125-10 mg/l for moxifloxacin, 0.125-50 mg/l for linezolid and 0.5-400 mg/l for piperacillin with an R2 > 0.997. Imprecision and inaccuracy values (both intra- and inter-assay) were ≤ 6.8% and ≤10.9% for all analytes in quality control samples, respectively. The assay proved to be selective for the study antibiotics, and the internal standards consistently compensated for matrix effects. The described simple and reliable HPLC-MS/MS assay is a powerful tool for routine TDM of cefepime, meropenem, ciprofloxacin, moxifloxacin, linezolid and piperacillin in human serum in clinical laboratories. With a total process time of approximately 30 min, it allows for accurate and selective quantification up to the expected pharmacokinetic peak concentrations.
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Svendsen T, Brodtkorb E, Reimers A, Molden E, Sætre E, Johannessen SI, Johannessen Landmark C. Pharmacokinetic variability, efficacy and tolerability of eslicarbazepine acetate-A national approach to the evaluation of therapeutic drug monitoring data and clinical outcome. Epilepsy Res 2017; 129:125-31. [PMID: 28043062 DOI: 10.1016/j.eplepsyres.2016.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/29/2016] [Accepted: 12/03/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Eslicarbazepine acetate (ESL) is a new antiepileptic drug (AED), still insufficiently studied regarding pharmacokinetic variability, efficacy and tolerability. The purpose of this study was to evaluate therapeutic drug monitoring (TDM) data in Norway and relate pharmacokinetic variability to clinical efficacy and tolerability in a long-term clinical setting in patients with refractory epilepsy. METHODS This retrospective observational study included TDM-data from the main laboratories and population data from the Norwegian Prescription Database in Norway, in addition to clinical data from medical records of adult patients using ESL for up to three years, whenever possible. RESULTS TDM-data from 168 patients were utilized for assessment of pharmacokinetic variability, consisting of 71% of the total number of patients in Norway using ESL, 2011-14. Median daily dose of ESL was 800mg (range 400-1600mg), and median serum concentration of ESL was 53μmol/L (range 13-132μmol/L). Inter-patient variability of ESL was extensive, with 25-fold variability in concentration/dose ratios. Additional clinical data were available from 104 adult patients out of the 168, all with drug resistant focal epilepsy. After 1, 2 and 3 years follow-up, the retention rate of ESL was 83%, 72% and 64%, respectively. ESL was generally well tolerated as add-on treatment, but sedation, cognitive impairment and hyponatremia were reported. Hyponatremia (sodium <137mmol/L) was present in 36% of the patients, and lead to discontinuation in three. CONCLUSION Pharmacokinetic variability of ESL was extensive and the demonstration of usefulness of TDM requires further studies. In patients with drug resistant focal Epilepsy, the high retention rate indicated good efficacy and tolerability. Hyponatremia was observed in one third of the patients. The present results point to a need for individualization of treatment and TDM may be useful.
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Dwivedi R, Gupta YK, Singh M, Joshi R, Tiwari P, Kaleekal T, Tripathi M. Correlation of saliva and serum free valproic acid concentrations in persons with epilepsy. Seizure 2014; 25:187-90. [PMID: 25455060 DOI: 10.1016/j.seizure.2014.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/29/2014] [Accepted: 10/18/2014] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Therapeutic drug monitoring (TDM) of antiepileptic drugs (AEDs) in serum is frequently used in clinical settings however saliva could be an alternative to measure free concentration of drugs. In the present study, we observed the possible correlation of VPA concentration between serum and saliva in persons with epilepsy (PWE). METHODS A total of 59 paired serum and saliva samples were assayed from 65 consecutive PWE (51 males and 14 females; age range 9-65 years). Patients were subjected to either VPA monotherapy or its combination with other AEDs for at least three months. Steady state trough concentration of unbound VPA drug was quantified using HPLC. The correlation between serum and saliva free VPA concentration was evaluated. RESULTS Out of 65 patients, 27 were on monotherapy of VPA and 38 were on VPA with other antiepileptic drugs. Saliva VPA concentration significantly correlated with serum free VPA concentration (p<0.05). Poor correlation was observed between serum and saliva VPA concentration with the daily dose (p>0.05) respectively. CONCLUSIONS Our study reveals that serum and saliva VPA concentrations are significantly associated in PWE. These associations may facilitate monitoring and evaluation of VPA levels non-invasively for PWE.
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Affiliation(s)
- Rekha Dwivedi
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Meenakshi Singh
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rupa Joshi
- Department of Pharmacology, AIIMS, New Delhi, India
| | - Prabhakar Tiwari
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Nosseir NS, Michels G, Binder P, Wiesen MHJ, Müller C. Simultaneous detection of ketamine, lorazepam, midazolam and sufentanil in human serum with liquid chromatography-tandem mass spectrometry for monitoring of analgosedation in critically ill patients. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 973C:133-141. [PMID: 25464106 DOI: 10.1016/j.jchromb.2014.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/28/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022]
Abstract
A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method has been developed and validated for the determination and quantification of four predominantly used analgosedatives in the intensive care unit: ketamine, lorazepam, midazolam and sufentanil in human serum. The extraction procedure consisted of protein precipitation of serum samples with acetonitrile and subsequent centrifugation. D5-fentanyl and D4-midazolam served as internal standards (ISTD). Separation of analytes was performed with a Hypersil C18 column and a mobile phase with acetonitrile and 0.1% formic acid (60/40, v/v) under isocratic conditions at a flow rate of 280μl/min. Analytes were simultaneously detected with a triple-stage quadrupole mass spectrometer (LC-MS/MS) in a selected reaction monitoring (SRM) mode with positive heated electrospray ionization (HESI) within a single 2-min run. Calibration curves were linear over a range of 50-2000 for ketamine, 10-1000 for lorazepam, 5-500 for midazolam and 1-100 for sufentanil (ng/ml). The limit of detection and the lower limit of quantification were 0.01 and 10.00 for ketamine, 0.005 and 10.00 for lorazepam, 0.018 and 5.00 for midazolam and 0.068 and 0.25 for sufentanil (ng/ml). Intra- and inter-day accuracies and precisions of all analytes were less than 15%. Bench stability with spiked serum samples was ensured after 12, 24 and 48h at room temperature, freeze- and thaw-stability after 3 cycles of thawing and freezing. The method was successfully established according to International Conference on Harmonization (ICH) guideline Q2 (R1) "Validation of Analytical Procedures" and applied in critically ill adult patients in the intensive care unit. We suggest its suitability for parallel quantification of the sedative analgesics ketamine, lorazepam, midazolam and sufentanil. The method serves as an instrumental tool for therapeutic drug monitoring (TDM) and pharmacokinetic studies [1].
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Affiliation(s)
- N S Nosseir
- Institute of Pharmacology, Department of Therapeutic Drug Monitoring, University Hospital of Cologne, Germany
| | - G Michels
- Department III of Internal Medicine, Heartcenter, University Hospital of Cologne, Germany
| | - P Binder
- Department III of Internal Medicine, Heartcenter, University Hospital of Cologne, Germany
| | - M H J Wiesen
- Institute of Pharmacology, Department of Therapeutic Drug Monitoring, University Hospital of Cologne, Germany
| | - C Müller
- Institute of Pharmacology, Department of Therapeutic Drug Monitoring, University Hospital of Cologne, Germany.
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Kang J, Park YS, Kim SH, Kim SH, Jun MY. Modern methods for analysis of antiepileptic drugs in the biological fluids for pharmacokinetics, bioequivalence and therapeutic drug monitoring. Korean J Physiol Pharmacol 2011; 15:67-81. [PMID: 21660146 DOI: 10.4196/kjpp.2011.15.2.67] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 04/10/2011] [Accepted: 04/15/2011] [Indexed: 12/20/2022]
Abstract
Epilepsy is a chronic disease occurring in approximately 1.0% of the world's population. About 30% of the epileptic patients treated with availably antiepileptic drugs (AEDs) continue to have seizures and are considered therapy-resistant or refractory patients. The ultimate goal for the use of AEDs is complete cessation of seizures without side effects. Because of a narrow therapeutic index of AEDs, a complete understanding of its clinical pharmacokinetics is essential for understanding of the pharmacodynamics of these drugs. These drug concentrations in biological fluids serve as surrogate markers and can be used to guide or target drug dosing. Because early studies demonstrated clinical and/or electroencephalographic correlations with serum concentrations of several AEDs, It has been almost 50 years since clinicians started using plasma concentrations of AEDs to optimize pharmacotherapy in patients with epilepsy. Therefore, validated analytical method for concentrations of AEDs in biological fluids is a necessity in order to explore pharmacokinetics, bioequivalence and TDM in various clinical situations. There are hundreds of published articles on the analysis of specific AEDs by a wide variety of analytical methods in biological samples have appears over the past decade. This review intends to provide an updated, concise overview on the modern method development for monitoring AEDs for pharmacokinetic studies, bioequivalence and therapeutic drug monitoring.
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Affiliation(s)
- Juseop Kang
- Pharmacology & Clinical Pharmacology Lab, College of Medicine, Hanyang University, Seoul 133-791, Korea
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