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Pharmaceuticals
Special Issues
Drug Analysis and Therapeutic Drug Monitoring
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Drug Analysis and Therapeutic Drug Monitoring

A special issue of Pharmaceuticals (ISSN 1424-8247). This special issue belongs to the section "Pharmacology".

Deadline for manuscript submissions: closed (25 June 2024) | Viewed by 7977

Special Issue Editors

Dr. Vanesa Escudero-Ortiz

E-Mail Website
Guest Editor
Pharmacy and Clinical Nutrition Group, Universidad CEU Cardenal Herrera, 03204 Elche, Alicante, Spain
Interests: personalized medicine; therapeutic drug monitoring; pharmacokinetics; pharmacodynamics; drug bioanalysis; clinical pharmaceutics
Dr. Ana Catalán Latorre

E-Mail Website
Guest Editor
Hospital Quironsalud Torrevieja, Ptda. de la Loma, s/n 03184 Alicante, Spain
Interests: therapeutic drug monitoring; pharmacokinetics; pharmacometrics; personalized medicine; clinical pharmaceutics; oncology; bioanalysis; chromatography
Dr. Manuel Sureda González

E-Mail Website
Guest Editor
Hospital Quironsalud Torrevieja, Ptda. de la Loma, s/n 03184 Alicante, Spain
Interests: cancer; pharmacology; immunotherapy; chemotherapy

Special Issue Information

Dear Colleagues,

Despite the complex pharmacokinetics of many drugs and pharmacological variabilities, fixed dosing is still used in many clinical treatments. This often results in large variability in intra- and inter-individual drug exposure and can lead to a significant proportion of patients experiencing toxicity or therapeutic failure, leading to poor patient outcomes and a significant health and economic burden.  The field of therapeutic drug monitoring (TDM) is becoming an important clinical decision support tool in different fields of pharmacotherapy and has been improved to provide in vivo pharmacokinetic information for the personalized modulation of drug regimens. The aim of this Special Issue is to collect research and/or review articles that show recent advances, not only in the most basic part of drug analysis, but also in its clinical implication as part of the therapeutic drug monitoring process. Therefore, there will be great interest in works that describe analytical techniques to quantify drugs in biological samples to pharmacokinetic–pharmacodynamic studies, exposure–toxicity or exposure–efficacy correlation studies, and safety studies or rational drug use studies, among others.  Based on your expertise in this field, we would like to invite you to contribute with a review or full research paper for peer review and possible publication in this Special Issue. Although the deadline to submit manuscripts for the Special Issue is October 31, 2023, I would appreciate hearing from you in the coming weeks if you are interested in submitting an article. Please do not hesitate to contact us if you feel that you need more time to prepare your manuscript.

Dr. Vanesa Escudero-Ortiz
Dr. Ana Catalán Latorre
Dr. Manuel Sureda González
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmaceuticals is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • personalized medicine
  • therapeutic drug monitoring
  • pharmacokinetics model
  • pharmacometric model
  • drug bioanalysis
  • clinical pharmaceutics

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Published Papers (4 papers)

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Research

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15 pages, 1263 KiB  
Article
Antipsychotics and Mortality in Adult and Geriatric Patients with Schizophrenia
by Ling-Ling Yeh, Wei-Chen Lee, Kuei-Hong Kuo and Yi-Ju Pan
Pharmaceuticals 2024, 17(1), 61; https://doi.org/10.3390/ph17010061 - 29 Dec 2023
Viewed by 1497
Abstract
Patients with schizophrenia have a high mortality risk, and the role of antipsychotic medications remains inconclusive. In an aging society, older patients with schizophrenia warrant increased attention. This study investigated the association of antipsychotic medication dosages with mortality in patients with schizophrenia by [...] Read more.
Patients with schizophrenia have a high mortality risk, and the role of antipsychotic medications remains inconclusive. In an aging society, older patients with schizophrenia warrant increased attention. This study investigated the association of antipsychotic medication dosages with mortality in patients with schizophrenia by using data from Taiwan’s National Health Insurance Research Database from 2010 to 2014. This study included 102,964 patients with schizophrenia and a subgroup of 6433 older patients in addition to an age- and sex-matched control group. The findings revealed that among patients with schizophrenia, the no antipsychotic exposure group had the highest mortality risk (3.61- and 3.37-fold higher risk for overall and cardiovascular mortality, respectively) in the age- and sex-adjusted model, followed by the high, low, and moderate exposure groups. A similar pattern was observed in the older patients with schizophrenia. High exposure to antipsychotics was associated with the highest risks of overall and cardiovascular mortality (3.01- and 2.95-fold higher risk, respectively). In conclusion, the use of antipsychotics can be beneficial for patients with schizophrenia with recommended exposure levels being low to moderate. In older patients, high antipsychotic exposure was associated with the highest mortality risk, indicating that clinicians should be cautious when administering antipsychotic medications to such patients. Full article
(This article belongs to the Special Issue Drug Analysis and Therapeutic Drug Monitoring)
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13 pages, 1449 KiB  
Article
Therapeutic Drug Monitoring and Pharmacogenetic Testing as Guides to Psychotropic Drug Dose Adjustment: An Observational Study
by Elodie Cuvelier, Houda Khazri, Cloé Lecluse, Benjamin Hennart, Ali Amad, Jean Roche, Michel Tod, Guillaume Vaiva, Olivier Cottencin, Pascal Odou, Delphine Allorge, Bertrand Décaudin and Nicolas Simon
Pharmaceuticals 2024, 17(1), 21; https://doi.org/10.3390/ph17010021 - 22 Dec 2023
Cited by 1 | Viewed by 1649
Abstract
To avoid the failures in therapy with psychotropic drugs, treatments can be personalized by applying the results of therapeutic drug monitoring and pharmacogenetic testing. The objective of the present single-center observational study was to describe the changes in psychotropic drug management prompted by [...] Read more.
To avoid the failures in therapy with psychotropic drugs, treatments can be personalized by applying the results of therapeutic drug monitoring and pharmacogenetic testing. The objective of the present single-center observational study was to describe the changes in psychotropic drug management prompted by therapeutic drug monitoring and pharmacogenetic testing, and to compare the effective drug concentration based on metabolic status with the dose predicted using an in silico decision tool for drug–drug interactions. The study was conducted in psychiatry wards at Lille University Hospital (Lille, France) between 2016 and 2020. Patients with data for at least one therapeutic drug monitoring session or pharmacogenetic test were included. Blood tests were performed for 490 inpatients (mainly indicated by treatment monitoring or failure) and mainly concerned clozapine (21.4%) and quetiapine (13.7%). Of the 617 initial therapeutic drug monitoring tests, 245 (40%) complied with good sampling practice. Of the patients, 51% had a drug concentration within the therapeutic range. Regardless of the drug concentration, the drug management did not change in 83% of cases. Thirty patients underwent pharmacogenetic testing (twenty-seven had also undergone therapeutic drug monitoring) for treatment failure; the plasma drug concentration was outside the reference range in 93% of cases. The patient’s metabolic status explained the treatment failure in 12 cases (40%), and prompted a switch to a drug metabolized by another CYP450 pathway in 5 cases (42%). Of the six tests that could be analyzed with the in silico decision tool, all of the drug concentrations after adjustment were included in the range estimated by the tool. Knowledge of a patient’s drug concentration and metabolic status (for CYD2D6 and CYP2C19) can help clinicians to optimize psychotropic drug adjustment. Drug management can be optimized with good sampling practice, support from a multidisciplinary team (a physician, a geneticist, and clinical pharmacist), and decision support tools. Full article
(This article belongs to the Special Issue Drug Analysis and Therapeutic Drug Monitoring)
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18 pages, 1951 KiB  
Article
Derivation and Clinical Utility of Safety Targets for Linezolid-Related Adverse Events in Drug-Resistant Tuberculosis Treatment
by Lina Keutzer, Laurynas Mockeliunas, Marieke G. G. Sturkenboom, Mathieu S. Bolhuis, Onno W. Akkerman and Ulrika S. H. Simonsson
Pharmaceuticals 2023, 16(11), 1575; https://doi.org/10.3390/ph16111575 - 8 Nov 2023
Viewed by 1180
Abstract
Long-term usage of linezolid can result in adverse events such as peripheral neuropathy, anemia and thrombocytopenia. Therapeutic drug monitoring data from 75 drug-resistant tuberculosis patients treated with linezolid were analyzed using a time-to-event (TTE) approach for peripheral neuropathy and anemia and indirect response [...] Read more.
Long-term usage of linezolid can result in adverse events such as peripheral neuropathy, anemia and thrombocytopenia. Therapeutic drug monitoring data from 75 drug-resistant tuberculosis patients treated with linezolid were analyzed using a time-to-event (TTE) approach for peripheral neuropathy and anemia and indirect response modelling for thrombocytopenia. Different time-varying linezolid pharmacokinetic exposure indices (AUC0–24h,ss, Cav, Cmax and Cmin) and patient characteristics were investigated as risk factors. A treatment duration shorter than 3 months was considered dropout and was modelled using a TTE approach. An exposure–response relationship between linezolid Cmin and both peripheral neuropathy and anemia was found. The exposure index which best described the development of thrombocytopenia was AUC0–24h. The final TTE dropout model indicated an association between linezolid Cmin and dropout. New safety targets for each adverse event were proposed which can be used for individualized linezolid dosing. According to the model predictions at 6 months of treatment, a Cmin of 0.11 mg/L and 1.4 mg/L should not be exceeded to keep the cumulative probability to develop anemia and peripheral neuropathy below 20%. The AUC0–24h should be below 111 h·mg/L or 270 h·mg/L to prevent thrombocytopenia and severe thrombocytopenia, respectively. A clinical utility assessment showed that the currently recommended dose of 600 mg once daily is safer compared to a 300 mg BID dosing strategy considering all four safety endpoints. Full article
(This article belongs to the Special Issue Drug Analysis and Therapeutic Drug Monitoring)
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Review

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20 pages, 940 KiB  
Review
Therapeutic Drug Monitoring in Psychiatry: Enhancing Treatment Precision and Patient Outcomes
by Letizia Biso, Stefano Aringhieri, Marco Carli, Marco Scarselli and Biancamaria Longoni
Pharmaceuticals 2024, 17(5), 642; https://doi.org/10.3390/ph17050642 - 16 May 2024
Cited by 4 | Viewed by 3029
Abstract
Psychiatric disorders often require pharmacological interventions to alleviate symptoms and improve quality of life. However, achieving an optimal therapeutic outcome is challenging due to several factors, including variability in the individual response, inter-individual differences in drug metabolism, and drug interactions in polytherapy. Therapeutic [...] Read more.
Psychiatric disorders often require pharmacological interventions to alleviate symptoms and improve quality of life. However, achieving an optimal therapeutic outcome is challenging due to several factors, including variability in the individual response, inter-individual differences in drug metabolism, and drug interactions in polytherapy. Therapeutic drug monitoring (TDM), by measuring drug concentrations in biological samples, represents a valuable tool to address these challenges, by tailoring medication regimens to each individual. This review analyzes the current landscape of TDM in psychiatric practice, highlighting its significance in optimizing drug dosages, minimizing adverse effects, and improving therapeutic efficacy. The metabolism of psychiatric medications (i.e., mood stabilizers, antipsychotics, antidepressants) often exhibits significant inter-patient variability. TDM can help address this variability by enhancing treatment personalization, facilitating early suboptimal- or toxic-level detection, and allowing for timely interventions to prevent treatment failure or adverse effects. Furthermore, this review briefly discusses technological advancements and analytical methods supporting the implementation of TDM in psychiatric settings. These innovations enable quick and cost-effective drug concentration measurements, fostering the widespread adoption of TDM as a routine practice in psychiatric care. In conclusion, the integration of TDM in psychiatry can improve treatment outcomes by individualizing medication regimens within the so-called precision medicine. Full article
(This article belongs to the Special Issue Drug Analysis and Therapeutic Drug Monitoring)
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