Therapeutic drug level testing based on Raman spectroscopy of the tear fluid

2018 ◽  
Author(s):  
Kana Kodama ◽  
Kenji Yamada
Keyword(s):  
Raman Spectroscopy ◽  
Drug Level ◽  
Tear Fluid ◽  
Therapeutic Drug

Paper-based surfaced enhanced Raman spectroscopy for drug level testing with tear fluid

2015 ◽  
Author(s):  
Kenji Yamada ◽  
Moe Yokoyama ◽  
Hieyong Jeong ◽  
Michiko Kido ◽  
Yuko Ohno
Keyword(s):  
Raman Spectroscopy ◽  
Drug Level ◽  
Tear Fluid

Drug level monitoring in palliative patients

2021 ◽  
pp. bmjspcare-2020-002613
Author(s):  
Joanne Bartlett ◽  
Elizabeth Freshwater
Keyword(s):  
Brain Tumour ◽  
Palliative Medicine ◽  
Drug Level ◽  
Therapeutic Drug ◽  
Primary Brain Tumour ◽  
Drug Level Monitoring ◽  
Symptoms And Signs ◽  
Level Monitoring ◽  
Palliative Patients

Palliative medicine is always patient centred and promotes the principle that no unnecessary investigations are performed. The case is reported of a patient with suspected carbamazepine toxicity presenting as progression of symptoms of primary brain tumour. A comparison is made of the symptoms and signs of toxicity versus tumour, and an aid for deciding when to perform therapeutic drug level monitoring for some common drugs.

scholarly journals P414 Risk factors for the development of anti-drug antibodies to infliximab and adalimumab in Crohn’s disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S378-S379
Author(s):  
E Khoo ◽  
A Lord ◽  
K Hanigan ◽  
A Croft ◽  
G Radford-Smith
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Lower Risk ◽  
Smoking Status ◽  
Drug Level ◽  
Enzyme Linked Immunosorbent Assay ◽  
Therapeutic Drug ◽  
Drug Levels ◽  
Low Serum

Abstract Background Anti-tumor necrosis factor-α (anti-TNFa) therapy have been established as an effective maintenance treatment for complicated Crohn’s Disease (CD). However, the efficacy of Infliximab (IFX) and Adalimumab (ADM) may be affected by low serum levels and/or the presence of anti-drug antibodies (ADA). This reinforces the importance of therapeutic drug monitoring (TDM). We aim to assess the clinical benefit of proactive vs. reactive TDM. Secondly, to assess the impact of TDM on clinical management. Thirdly, to identify risk factors for low serum drug levels and the development of ADA in CD patients. Methods This was a single-centred observational cohort study performed at a tertiary hospital, comprising of total 229 CD patients: 142 received IFX and 87 received ADM, who have had a trough drug level, tested using enzyme-linked immunosorbent assay. Demographic and clinical data were retrospectively collected from electronic medical records. Fisher’s Exact Test was used to determine if there are nonrandom associations between variables. A p-value of less than 0.05 was considered statistically significant. Results One hundred and fourteen patients (49%) receiving a standard anti-TNFa regimen had subtherapeutic drug levels (67 had IFX < 3 μg/ml and 47 had ADM < 5 μg/ml). Interestingly, almost half of this cohort were asymptomatic. Reactive TDM completed among symptomatic patients have shown to have a statistically significant benefit in detecting subtherapeutic drug level (p = 0.0001). Following these results, only fifty-two patients (46%) had a change of therapy (29 IFX, 25 ADM); while the remaining sixty-two patients (54%) continued the same dosing regimen with only one documented admission within 90-days following the drug level being taken. Eight patients (4%) were found to have positive ADA, all in the presence of subtherapeutic drug levels. Two of these had a subsequent flare of their disease. They were all switched to another class of biologic therapy. Non-smoking status at diagnosis and the concomitant use of immunomodulator were found to have statistically significant associations with a therapeutic drug level (p = 0.0176 and p = 0.0001, respectively). Similarly, both of these risk factors were associated with lower risk of ADA formation (p = 0.0057 and p = 0.0165, respectively). Conclusion This study suggests that a large proportion of patients have subtherapeutic drug levels at standard dosing schedules. However, low drug levels do not correlate with a higher risk of complications if patients are in clinical remission. The results of this study also indicate that non-smoking status at diagnosis and the concomitant use of immunomodulator are associated with higher serum drug levels and lower risk of developing anti-drug antibodies.

Methotrexate Blood Level Monitoring

1985 ◽  
Vol 19 (5) ◽  
pp. 372-373 ◽  
Author(s):  
Helen St.C. Remington ◽  
Clifford C. Bailey
Keyword(s):  
Blood Level ◽  
Fluid Balance ◽  
Drug Level ◽  
Therapeutic Drug ◽  
High Dose ◽  
High Dose Therapy ◽  
Methotrexate Toxicity ◽  
Management Procedures ◽  
Drug Level Monitoring ◽  
Level Monitoring

Methotrexate toxicity can be avoided following high-dose therapy if certain management procedures are adhered to. These include careful fluid balance management and therapeutic drug level monitoring. A case is reported of an episode of methotrexate toxicity resulting from a fluid balance problem.

PRESCRIBING AND MONITORING OF GENTAMICIN IN NEONATES

2016 ◽  
Vol 101 (9) ◽  
pp. e2.65-e2 ◽  
Author(s):  
Nicola Staton
Keyword(s):  
Blood Culture ◽  
Neonatal Intensive Care ◽  
Drug Level ◽  
Neonatal Infection ◽  
Blood Cultures ◽  
Therapeutic Drug ◽  
Before And After ◽  
National Patient ◽  
Trough Levels ◽  
Selection Of

AimTo evaluate the implementation of the National Institute for Health and Care Excellence (NICE) clinical guideline1 with regards to the prescribing, exposure and therapeutic drug level monitoring of gentamicin in early onset neonatal infection.MethodA selection of drug charts for babies who were prescribed gentamicin within 72 hrs of birth were reviewed. The number of doses of gentamicin administered, C-reactive protein (CRP) results, blood culture results and gentamicin trough levels were recorded. A new gentamicin prescription chart was developed based on the NICE clinical guideline1 and the National Patient Safety Agency (NPSA) alert2 on the safer use of gentamicin for neonates, and was launched on the Neonatal Intensive Care Unit (NICU). A number of months after the new gentamicin prescription chart was introduced, and had therefore had time to become embedded into practice, a selection of babies' drug charts were reviewed and the same information as previously was documented. The information obtained before and after the introduction of the new gentamicin prescription chart was compared.ResultsPrior to the new gentamicin prescription chart 16 prescriptions for gentamicin were reviewed, and in total 47 doses of gentamicin were administered. Blood cultures were negative after five days in all 16 patients. In total 9 gentamicin trough levels were taken with only one level being >2 mg/L. Following the introduction of the new prescription chart another 16 prescriptions for gentamicin were reviewed, and in total 38 doses of gentamicin were administered. Again blood cultures were negative after five days in all 16 patients. In total 14 gentamicin trough levels were taken with two levels being >2 mg/L. Prior to the new gentamicin prescription chart 50% of babies received more than one dose of gentamicin despite having two CRP results <10. This is compared to 31% of babies following the introduction of the new gentamicin prescription chart.ConclusionIt can be concluded that the new gentamicin prescription chart has resulted in a reduction in the exposure of babies to gentamicin, as all babies now have it administered at 36 hourly intervals. There has also been an increase in blood monitoring of trough gentamicin levels, as they are now taken prior to the second dose rather than the third dose. Therefore the new gentamicin prescription chart is safer as toxic levels are identified sooner, which reduces the risk of babies suffering adverse effects.Since the introduction of the new gentamicin prescription chart 31% of babies received more than the necessary number of gentamicin doses, as dictated by the CRP results and blood culture result at 36 hrs. This is a learning point which will be highlighted to the medical and nursing staff on NICU.

scholarly journals ASSESSING ANTI-TNF TROUGH LEVELS AND ITS APPLICABILITY IN DAILY PRACTICE IN SPONDYLOARTHRITIS PATIENTS

2016 ◽  
Vol 25 (3) ◽  
pp. 127-135
Author(s):  
Claudia Deaconu ◽  
◽  
Daniela Opris ◽  
Ruxandra Ionescu ◽  
◽  
...  
Keyword(s):  
Disease Activity ◽  
Drug Level ◽  
Daily Practice ◽  
Serum Levels ◽  
Antibody Detection ◽  
Therapeutic Drug ◽  
Study Cohort ◽  
Serum Drug Level ◽  
One Year ◽  
Trough Levels

Objective. The purpose of the present study was to assess the relevance of therapeutic drug monitoring in spondyloarthritis patients, by determining drug serum levels and anti-drug antibodies and estimating cut-off values for three TNF inhibitors. Methods. Over one year, we enrolled 100 patients with SpA, under consequent treatment with adalimumab (ADL), etanercept (ETA) or infliximab (IFX). Demographic, clinical (BASDAI, ASDAS) and laboratory (ESR, CRP) data was collected together with drug serum level and anti-drug antibodies using the ELISA technique. The statistical analysis was performed using the SPSS software, version 20.0 with the aid of Student t-test, Spearman and Pearson tests. Results. Out of the study cohort, 35% were on ADL, 33% on IFX, and 32% under ETA treatment. Undetectable drug levels correlated to the presence of anti-drug antibodies and to disease activity scores. There were no identified anti-ETA antibodies. For this study lot trough levels are estimated between 2 and 4 μg/mL for an ASDAS-CRP under 2.1. Conclusion. Serum drug level measurement and anti-drug antibody detection can be used as a completion to a clinician’s tools in assessing disease activity, leading to an optimal and personalized manner of patient management.

scholarly journals Therapeutic Drug Monitoring: Performance of a FRET-Based Point-Of-Care Immunoassay for the Quantitation of Infliximab and Adalimumab in Blood

2020 ◽  
Author(s):  
Edgar Ong ◽  
Ruo Huang ◽  
Richard Kirkland ◽  
Stefan Westin ◽  
Jared Salbato ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Whole Blood ◽  
Point Of Care ◽  
Resonance Energy Transfer ◽  
Resonance Energy ◽  
Drug Level ◽  
Analytical Performance ◽  
Quantitative Detection ◽  
Therapeutic Drug

<p>Two fast (<5 min), time-resolved fluorescence resonance energy transfer (FRET)-based immunoassays (Procise IFX™ and Procise ADL™) were developed for the quantitative detection of infliximab (IFX), adalimumab (ADL), and their respective biosimilars for use in therapeutic drug monitoring (TDM) using 20 µL of finger prick whole blood at the point-of-care or whole blood/serum in a central lab. Studies were performed to characterize analytical performance of the Procise IFX and the Procise ADL assays on the ProciseDx™ analyzer.</p> <p><br></p><p>The Procise IFX and Procise ADL assays both showed good analytical performance with respect to sensitivity, specificity, linearity, and precision suitable for routine clinical use as well as excellent correlation to current commercial ELISA IFX and ADL measurement methods.</p> <p><br></p><p>Results indicated that the Procise IFX and Procise ADL assays are sensitive, specific, and precise yielding results in less than 5 minutes from either whole blood or serum. This indicates the Procise IFX and Procise ADL assays are useful for obtaining fast and accurate IFX or ADL quantitation, thus avoiding delays inherent to current methods and enabling immediate drug level dosing decisions to be made during a single patient visit.</p>

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