Recent advances in analytical methods for the therapeutic drug monitoring of immunosuppressive drugs

Drug Test Anal. 2018 Jan;10(1):81-94. doi: 10.1002/dta.2290. Epub 2017 Sep 28.

Abstract

Therapeutic drug monitoring (TDM) of immunosuppressive drugs (ISDs) with a narrow therapeutic index is an increasingly popular tool for minimizing drug toxicity while maximizing the prevention of graft loss and organ rejection. This review focuses on trends regarding analytical methods for the TDM of ISDs since 2011. The five most commonly prescribed immunosuppressive medications are critically reviewed: cyclosporine A, tacrolimus, sirolimus (rapamycin), everolimus, and mycophenolic acid. This review introduces the general background of TDM and ISDs and presents the recent developments in using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and immunoassays for the TDM of ISDs. Finally, a future perspective for these analytical methods is briefly discussed.

Keywords: Immunoassay; Immunosuppressive drugs; Liquid chromatography; Mass spectrometry; Therapeutic drug monitoring.

Publication types

  • Review

MeSH terms

  • Chromatography, Liquid / methods
  • Chromatography, Liquid / trends
  • Cyclosporine / analysis
  • Cyclosporine / blood
  • Cyclosporine / therapeutic use
  • Drug Monitoring / methods*
  • Drug Monitoring / trends*
  • Everolimus / analysis
  • Everolimus / blood
  • Everolimus / therapeutic use
  • Graft Rejection / blood
  • Graft Rejection / drug therapy
  • Graft Rejection / immunology
  • Humans
  • Immunosuppressive Agents / analysis*
  • Immunosuppressive Agents / blood
  • Immunosuppressive Agents / therapeutic use*
  • Sirolimus / analysis
  • Sirolimus / blood
  • Sirolimus / therapeutic use
  • Tacrolimus / analysis
  • Tacrolimus / blood
  • Tacrolimus / therapeutic use
  • Tandem Mass Spectrometry / methods
  • Tandem Mass Spectrometry / trends

Substances

  • Immunosuppressive Agents
  • Cyclosporine
  • Everolimus
  • Sirolimus
  • Tacrolimus