Evaluation of the clinical and quantitative performance of a practical HPLC-UV platform for in-hospital routine therapeutic drug monitoring of multiple drugs

Go Morikawa; Kazuto Fukami; Yukiko Moriiwa; Katsuko Okazawa; Akio Yanagida

doi:10.1186/s40780-023-00298-7

Evaluation of the clinical and quantitative performance of a practical HPLC-UV platform for in-hospital routine therapeutic drug monitoring of multiple drugs

J Pharm Health Care Sci. 2023 Oct 1;9(1):29. doi: 10.1186/s40780-023-00298-7.

Authors

Go Morikawa¹, Kazuto Fukami², Yukiko Moriiwa³, Katsuko Okazawa⁴, Akio Yanagida³

Affiliations

¹ Department of Pharmacy, Hokushin General Hospital, 1-5-63, Nishi, Nakano, Nagano, 383-8505, Japan. gomorikawa@hokushin-hosp.jp.
² Department of Clinical laboratory, Hokushin General Hospital, 1-5-63, Nishi, Nakano, Nagano, 383-8505, Japan.
³ Department of Biomedical Analysis, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, 192-0392, Japan.
⁴ Department of Pharmacy, Hokushin General Hospital, 1-5-63, Nishi, Nakano, Nagano, 383-8505, Japan.

Abstract

Background: In-hospital therapeutic drug monitoring (TDM) requires a suitable quantification method for target drugs from the viewpoint of precision, throughput, and testing costs. We previously developed a practical HPLC-UV platform for quantification of serum levels of various drugs. In this report, the platform was effectively applied to the quantification of patient serum levels of five different drugs by clinical professionals in our hospital during their daily work.

Methods: The residual sera of patients receiving carbamazepine (CBZ), phenytoin (PHT), lamotrigine (LTG), vancomycin (VCM), or voriconazole (VRCZ) were used in the present clinical study. The quantification method for each drug consisted of rapid solid-phase extraction (SPE) of each drug in the patient serum, followed by optimized HPLC-UV analysis of the drug in the SPE eluate. Furthermore, patient serum levels of PHT, CBZ, and VCM were also measured by ligand-binding assay using a cobas^® analyzer in our hospital, and those of LTG and VRCZ were measured by HPLC-MS/MS at an outsourced provider. Passing-Bablok regression analysis and Bland-Altman analysis were employed to analyze the agreement of drug levels in patient sera, which was separately quantified using two different methods-our HPLC-UV platform and the cobas analyzer, or HPLC-UV and HPLC-MS/MS.

Results: All analytical conditions of the present method using our HPLC-UV platform were well optimized for each target drug quantification in the patient's serum, and the quantification method for each drug was fully validated for accuracy, precision and reproducibility. Furthermore, Passing-Bablok regression analysis and Bland-Altman analysis revealed that patient serum levels of PHT, CBZ, and VCM quantified by our HPLC-UV platform were closely correlated with those quantified by the cobas^® analyzer, and the levels of LTG and VRCZ quantified by our HPLC-UV platform were also correlated with those quantified by HPLC-MS/MS.

Conclusions: Our HPLC-UV platform can be performed without requiring special analytical techniques. This platform is expected to be used for the measurement of blood levels of multiple drugs for in-hospital routine TDM.

Keywords: Anticonvulsant; Antimicrobial; HPLC-UV; Solid-phase extraction; Therapeutic drug monitoring.