Clozapine blood level assessment using a point-of-care device: feasibility and reliability

Background: Therapeutic drug monitoring (TDM) is useful to assess clozapine adherence and optimize treatment. However, analysis of venous blood levels by liquid chromatography tandem mass spectrometry (LC-MS/MS) is often logistically complicated and process time is prolonged. Objective: To assess th...

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Bibliographic Details
Published in:	Therapeutic advances in psychopharmacology Vol. 12; p. 20451253221094435
Main Authors:	Kamhi-Nesher, Shiri, Taub, Sharon, Halimi, Shikma, Frenkel, Maria, Azam, Mahmud, Bormant, Gil, Isakov, Helena, Radzinsky, Dikla, Weizman, Abraham, Krivoy, Amir
Format:	Journal Article
Language:	English
Published:	London, England SAGE Publications 2022 Sage Publications Ltd SAGE Publishing
Subjects:	Antipsychotics Blood tests Original Research Patient compliance Point of care testing Regression analysis clozapine point of care schizophrenia therapeutic drug monitoring
Online Access:	Get full text
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Summary:	Background: Therapeutic drug monitoring (TDM) is useful to assess clozapine adherence and optimize treatment. However, analysis of venous blood levels by liquid chromatography tandem mass spectrometry (LC-MS/MS) is often logistically complicated and process time is prolonged. Objective: To assess the feasibility and reliability of a new point-of-care device, (MyCare™ Insite), using capillary blood for clozapine therapeutic monitoring. Methods: Matched venous and capillary blood samples were collected from patients treated with clozapine on a stable dose. Samples were analyzed by LC-MS/MS and MyCare Insite Clozapine Test. Clozapine plasma levels were compared between methods using linear regression model. Both patients and treatment team completed questionnaires about the feasibility of blood sampling. Results: Of the total sample (44 patients, 61% males, mean age 43 ± 12 years), mean daily clozapine dose was 293 ± 134 mg/day. Linear regression model demonstrated high correlation with R2 = 0.83 (p < 0.0001) and mean difference of 26 ± 162 ng/ml. More than 60% of the patients found the clozapine TDM to be important. Most of the participants (58%) favored the capillary sampling and 11% claimed that testing method would affect their adherence to TDM. Moreover, a larger portion (72%) strongly preferred to be tested at the office rather than at the lab. Conclusions: The point-of-care device offers an accessible and satisfactory measurement of clozapine blood levels. Both patients and healthcare providers reported preference for capillary sampling as well as for the in-office TDM procedure. The immediate results provided by the device can facilitate rapid and informed clinical decisions and therefore improve clozapine treatment outcomes.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2045-1253 2045-1261
DOI:	10.1177/20451253221094435