Performance evaluation of enzyme immunoassay for voriconazole therapeutic drug monitoring with automated clinical chemistry analyzers

• Published in: Practical laboratory medicine Vol. 8; pp. 86 - 94
• Main Authors: Jeon, Yongbum, Han, Minje, Han, Eun Young, Lee, Kyunghoon, Song, Junghan, Song, Sang Hoon
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-08-2017; Elsevier
• Subjects: Antifungal agents; Therapeutic drug monitoring; Voriconazole; CLSI; LoD; UV; G6PDH; Antifungal agents; MRM; RMSSD; LoQ; NAD; Therapeutic drug monitoring; LC-MS/MS; SD; CV; Voriconazole; TDM; HPLC; LoB; CV, coefficient of variation; G6PDH, glucose-6-phosphate dehydrogenase; NAD, nicotinamide adenine dinucleotide; LC-MS/MS, liquid chromatography-tandem mass spectrometry; LoB, limit of blank; UV, ultraviolet; CLSI, Clinical and Laboratory Standards Institute; HPLC, high-performance liquid chromatography; RMSSD, root mean square standard deviation; LoD, limit of detection; SD, standard deviation; LoQ, limit of quantitation; MRM, multiple reaction monitoring; TDM, therapeutic drug monitoring
• ISSN: 2352-5517; 2352-5517
• DOI: 10.1016/j.plabm.2017.05.002

Voriconazole is a triazole antifungal developed for the treatment of fungal infectious disease, and the clinical utility of its therapeutic drug monitoring has been evaluated. Recently, a new assay for analyzing the serum voriconazole concentration with an automated clinical chemistry analyzer was developed. We evaluated the performance of the new assay based on standardized protocols.
The analytical performance of the assay was evaluated according to its precision, trueness by recovery, limit of quantitation, linearity, and correlation with results from liquid chromatography-tandem mass spectrometry (LC-MS/MS). The evaluation was performed with the same protocol on two different routine chemistry analyzers. All evaluations were performed according to CLSI Guidelines EP15, EP17, EP6, and EP9 [1–4].
Coefficients of variation for within-run and between-day imprecision were 3.2–5.1% and 1.5–3.0%, respectively, on the two different analyzers for pooled serum samples. The recovery rates were in the range of 95.4–102.2%. The limit of blank was 0.0049μg/mL, and the limit of detection of the samples was 0.0266–0.0376μg/mL. The percent recovery at three LoQ levels were 67.9–74.6% for 0.50μg/mL, 75.5–80.2% for 0.60μg/mL, and 89.9–96.6% for 0.70μg/mL. A linear relationship was demonstrated between 0.5μg/mL and 16.0μg/mL (R2=0.9995–0.9998). The assay correlated well with LC-MS/MS results (R2=0.9739–0.9828).
The assay showed acceptable precision, trueness, linearity, and limit of quantification, and correlated well with LC-MS/MS. Therefore, its analytical performance is satisfactory for monitoring the drug concentration of voriconazole.