On the Slow Diffusion of Point-of-Care Systems in Therapeutic Drug Monitoring

Abstract

Recent advancements in point-of-care (PoC) technologies show great transformative promises for personalized preventative and predictive medicine. However, fields like therapeutic drug monitoring (TDM), that first allowed for personalized treatment of patients’ disease, still lag behind in the widespread application of PoC devices for monitoring of patients. Surprisingly, very few applications in commonly monitored drugs, such as anti-epileptics, are paving the way for a PoC approach to patient therapy monitoring compared to other fields like intensive care cardiac markers monitoring, glycemic controls in diabetes, or bench-top hematological parameters analysis at the local drug store. Such delay in the development of portable fast clinically effective drug monitoring devices is in our opinion due more to an inertial drag on the pervasiveness of these new devices into the clinical field than a lack of technical capability. At the same time, some very promising technologies failed in the clinical practice for inadequate understanding of the outcome parameters necessary for a relevant technological breakthrough that has superior clinical performance. We hope, by over-viewing both TDM practice and its yet unmet needs and latest advancement in micro- and nanotechnology applications to PoC clinical devices, to help bridging the two communities, the one exploiting analytical technologies and the one mastering the most advanced techniques, into translating existing and forthcoming technologies in effective devices.

Bioluminescent Antibodies for Point‐of‐Care Diagnostics

“…One of the challenges in the field is the development of generally applicable approaches to quantify drugs for PoC therapeutic drug monitoring (TDM) 1. TDM is mostly based on mass‐spectrometry or antibody‐based immunoassays, both of which require specialized instrumentation or multiple assay steps, thus making their use for PoC applications by non‐expert users problematic 2, 3.…”

Bioluminescent Antibodies for Point‐of‐Care Diagnostics

“…[1] TDM is mostly based on mass-spectrometry or antibody-based immunoassays,b oth of which require specialized instrumentation or multiple assay steps,t hus making their use for PoCa pplications by non-expert users problematic. [2,3] Even though the generation of specific antibodies against various analytes is aroutine procedure,approaches to transfer the specific binding of antibodies into as ignal readout compatible with cheap and portable devices are needed.…”

Biosensors and personalized drug therapy: what does the future hold?

“…aminoglycosides, vancomycin, or ß-lactams), antidepressants, antipsychotics, caffeine (in case of apnea in preterm infants), as well as immunosuppressive, antiarrhythmic (e.g. digoxin), and many antiepileptic agents for chronic therapy [3].…”

“…In comparison with numerous systems in clinical and on-site diagnostics, the use of biosensors in TDM has not made a breakthrough yet [3]. For sure, the decisive point here lies on a 'killer' application like at-home pregnancy tests by lateral flow assays or diabetes monitoring by blood glucose meters.…”