Therapeutic Drug Monitoring of Antiretroviral Drugs at Home Using Dried Blood Spots: A Proof-Of-Concept Study

Kromdijk, Wiete; Mulder, J.; Smit, Patrick M.; Heine, Rob ter; Beijnen, Jos H.; Huitema, Alwin D. R.

doi:10.3851/imp2501

Cited by 28 publications

(27 citation statements)

References 13 publications

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“…Previous studies with DBS analysis of antiretroviral and immunosuppressive drugs showed that 87.5 to 98% of the DBS samples obtained by patients were suitable for analysis (41,42). Besides, when the samples are sent by mail, the physician already has the results of the analysis before the consultation.…”

Section: Discussionmentioning

confidence: 99%

Dried Blood Spot Analysis Suitable for Therapeutic Drug Monitoring of Voriconazole, Fluconazole, and Posaconazole

Elst

Span

Hateren

et al. 2013

Antimicrob Agents Chemother

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e Invasive aspergillosis and candidemia are important causes of morbidity and mortality in immunocompromised and critically ill patients. The triazoles voriconazole, fluconazole, and posaconazole are widely used for the treatment and prophylaxis of these fungal infections. Due to the variability of the pharmacokinetics of the triazoles among and within individual patients, therapeutic drug monitoring is important for optimizing the efficacy and safety of antifungal treatment. A dried blood spot (DBS) analysis was developed and was clinically validated for voriconazole, fluconazole, and posaconazole in 28 patients. Furthermore, a questionnaire was administered to evaluate the patients' opinions of the sampling method. The DBS analytical method showed linearity over the concentration range measured for all triazoles. Results for accuracy and precision were within accepted ranges; samples were stable at room temperature for at least 12 days; and different hematocrit values and blood spot volumes had no significant influence. The ratio of the drug concentration in DBS samples to that in plasma was 1.0 for voriconazole and fluconazole and 0.9 for posaconazole. Sixty percent of the patients preferred DBS analysis as a sampling method; 15% preferred venous blood sampling; and 25% had no preferred method. There was significantly less perception of pain with the DBS sampling method (P ‫؍‬ 0.021). In conclusion, DBS analysis is a reliable alternative to venous blood sampling and can be used for therapeutic drug monitoring of voriconazole, fluconazole, and posaconazole. Patients were satisfied with DBS sampling and had less pain than with venous sampling. Most patients preferred DBS sampling to venous blood sampling.

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Section: Discussionmentioning

confidence: 99%

Dried Blood Spot Analysis Suitable for Therapeutic Drug Monitoring of Voriconazole, Fluconazole, and Posaconazole

Elst

Span

Hateren

et al. 2013

Antimicrob Agents Chemother

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“…9 Other studies focused on the feasibility of DBS home sampling in the context of patient sampling performance and sample quality. [10][11][12][13][14] Given that using DBS home sampling could result in up-todate blood levels of tacrolimus readily available at every consultation, we hypothesized that implementing DBS would increase the rate of tapering of outpatient visits and therefore would lower total health care costs. In this randomized controlled hybrid implementation trial, we aimed to assess whether the use of DBS home sampling in the first 6 months after kidney transplantation would result in fewer clinical consultations and lower costs from a societal perspective compared to usual care.…”

Section: Introductionmentioning

confidence: 99%

Effects, costs and implementation of monitoring kidney transplant patients' tacrolimus levels with dried blood spot sampling: A randomized controlled hybrid implementation trial

Veenhof

Boven

Voort

et al. 2020

Brit J Clinical Pharma

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Aims: Dried blood spot (DBS) home sampling allows monitoring creatinine levels and tacrolimus trough levels as an alternative for blood sampling in the hospital, which is important in kidney transplant patient follow-up. This study aims to assess whether DBS home sampling results in decreased patient travel burden and lower societal costs. Methods: In this single-centre randomized controlled hybrid implementation trial, adult kidney transplant patients were enrolled. The intervention group (n = 25) used DBS home sampling on top of usual care in the first 6 months after transplantation. The control group (n = 23) received usual care only. The primary endpoint was the number of outpatient visits. Other endpoints were costs per patient, patient satisfaction and implementation.Results: There was no statistically significant difference in the average number of outpatient visits between the DBS group (11.2, standard deviation: 1.7) and the control group (10.9, standard deviation: 1.4; P = .48). Average costs per visit in the DBS group were not significantly different (€542, 95% confidence interval €316-990) compared to the control group (€533, 95% confidence interval €278-1093; P = .66).Most patients (n = 19/23, 82.6%) were willing to perform DBS home-sampling if this would reduce the number of hospital visits. Only 55.9% (n = 143/256) of the expected DBS samples were received and 1/5 analysed on time (n = 52/256). Conclusion: Adult kidney transplant patients are willing to perform DBS home sampling. However, to decrease patient travel burden and costs in post-transplant care, optimization of the logistical process concerning mailing and analysis of DBS samples is crucial. K E Y W O R D S cost-effectiveness, dried blood spots, implementation, randomized controlled trialThe authors confirm that the Principal Investigator for this paper is Daniël Johannes Touw and that he had direct clinical responsibility for the patients in this trial.

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“…The DBS sampling method has been successfully applied for the determination of drug concentrations in numerous TK and PK studies [12][13][14][15][16], as well as for therapeutic drug monitoring [17][18][19][20]. Some studies have shown that DBS sampling could also be used for individual cytochrome phenotyping of either CYP2C9 [2,21] or CYP3A [22] activities.…”

mentioning

confidence: 99%

Simultaneous LC–MS/MS Quantification of P-Glycoprotein and Cytochrome P450 Probe Substrates and Their Metabolites in DBS and Plasma

et al. 2014

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Therapeutic Drug Monitoring of Antiretroviral Drugs at Home Using Dried Blood Spots: A Proof-Of-Concept Study

Abstract: This proof-of-concept study confirms the feasibility of TDM of antiretroviral drugs using DBS with sampling at home, thereby opening the possibility to obtain trough concentrations at home in populations where venous sampling is difficult.

Cited by 28 publications

References 13 publications

Dried Blood Spot Analysis Suitable for Therapeutic Drug Monitoring of Voriconazole, Fluconazole, and Posaconazole

Dried Blood Spot Analysis Suitable for Therapeutic Drug Monitoring of Voriconazole, Fluconazole, and Posaconazole

Effects, costs and implementation of monitoring kidney transplant patients' tacrolimus levels with dried blood spot sampling: A randomized controlled hybrid implementation trial

Simultaneous LC–MS/MS Quantification of P-Glycoprotein and Cytochrome P450 Probe Substrates and Their Metabolites in DBS and Plasma

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