Dried blood microsampling-assisted therapeutic drug monitoring of immunosuppressants: An overview

• Published in: Journal of Chromatography A Vol. 1689; p. 463724
• Main Authors: Deprez, Sigrid, Stove, Christophe P.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 25-01-2023
• Subjects: (Volumetric) dried blood spots; Chromatography, Liquid - methods; Clinical application; Dried Blood Spot Testing - methods; Drug Monitoring - methods; Humans; Immunosuppressants; Immunosuppressive Agents - therapeutic use; Liquid chromatography-tandem mass spectrometry; Quality of Life; Specimen Handling - methods; Therapeutic drug monitoring; Therapeutic drug monitoring; Liquid chromatography-tandem mass spectrometry; Immunosuppressants; Clinical application; (Volumetric) dried blood spots
• ISSN: 0021-9673; 1873-3778
• DOI: 10.1016/j.chroma.2022.463724

•State-of-the-art of immunosuppressants analysis in (volumetric) dried blood samples.•Critical discussion of challenges related to quantification of immunosuppressant drugs.•Implementation status in clinical practice and attention for the patients’ perception.•Considerations to overcome obstacles for implementation into clinical practice.
In the field of solid organ transplantation, chemotherapy and autoimmune disorders, treatment with immunosuppressant drugs requires intensive follow-up of the blood concentrations via therapeutic drug monitoring (TDM) because of their narrow therapeutic window and high intra- and inter-subject variability. This requires frequent hospital visits and venepunctures to allow the determination of these analytes, putting a high burden on the patients. In the context of patient-centric thinking, it is becoming increasingly established that at least part of these conventional blood draws could be replaced by microsampling, allowing home-sampling and increasing the quality of life for these patients. In this review we discuss the published methods - mostly using liquid chromatography coupled to tandem mass spectrometry - that have utilized (volumetric) dried blood samples as an alternative for conventional liquid whole blood for the TDM of immunosuppressant drugs. Furthermore, some pre-analytical considerations using DBS or volumetric alternatives are considered, as well as the applicability on clinical samples. The implementation status in clinical practice is also discussed, including (1) the cost-effectiveness of this approach compared to venepuncture, (2) the availability of multiplexed methods, (3) the status of harmonization and (4) patient perception. A brief perspective on potential future developments for the dried blood-based TDM of immunosuppressant drugs is provided, by considering how obstacles for the implementation of these strategies into clinical practice might be overcome.