A novel approach to therapeutic drug monitoring of Ciclosporin in pediatric renal transplant recipients using volumetric absorptive microsampling (VAMS) - Teaching old dog new tricks

A systematic review found mixed economic evidence for microsampling in therapeutic drug monitoring; one study reported no cost reduction with DBS home-sampling, €688 versus €676, whilst another predicted savings up to 61%. The authors caution that more work is required to assess costs alongside clinical outcomes and optimise logistics for decentralised implementation.

The economic evidence for microsampling to support therapeutic drug monitoring: A systematic review — Carland et al., British Journal of Clinical Pharmacology (paywalled) · source ↗

• vams
• blood
• economics
• dbs
• tdm
• self-collection
• dried
• antimicrobials
• pediatric
• immunosuppressants
• validation

Dried saliva collected with the Mitra device correlated strongly with wet saliva but poorly with plasma unbound and total concentrations, indicating it is not a reliable substitute for plasma in routine therapeutic drug monitoring of mycophenolic acid and its glucuronide metabolite. Capillary blood collected via VAMS remains a promising alternative for long term monitoring in paediatric patients.

Volumetric Absorptive Microsampling of Saliva for Pharmacokinetic Evaluation of Mycophenolic Acid and Its Glucuronide Metabolite in Pediatric Renal Transplant Recipients: Bioanalytical Method Validation and Clinical Feasibility Evaluation — Kocur et al., Pharmaceuticals · source ↗

• blood
• saliva
• dried
• capillary
• vams
• neoteryx-mitra
• validation
• pediatric
• tdm
• immunosuppressants

In children with SLE, VAMS finger-prick capillary blood gave haematocrit-adjusted MPA and MPAG concentrations indistinguishable from plasma, and the AUC from VAMS derived plasma-equivalent concentrations matched plasma AUC with R2 0.97. This supports accurate pharmacokinetically guided dosing of MMF using only three timed capillary microsamples.

Volumetric Absorptive Microsampling Combined with Mass Spectrometry to Support Pharmacokinetically-Guided Precision Dosing of Mycophenolate Mofetil in Pediatric Lupus Nephritis Patients — Zhao et al., The journal of applied laboratory medicine (paywalled) · source ↗

• vams
• venous-agreement
• blood
• tdm
• haematocrit
• dried
• capillary
• pediatric
• immunosuppressants
• validation

The study validated a VAMS-based LC-MS/MS method for measuring sirolimus levels, showing it was clinically equivalent to the standard whole blood method and suitable for therapeutic drug monitoring in paediatric transplant patients, supporting the use of decentralised microsampling for this purpose.

Personalization of pharmacotherapy with sirolimus based on volumetric absorptive microsampling (VAMS) in pediatric renal transplant recipients-from LC-MS/MS method validation to clinical application — Kocur et al., Pharmacological reports : PR · source ↗

• vams
• venous-agreement
• neoteryx-mitra
• blood
• tdm
• haematocrit
• dried
• capillary
• pediatric
• immunosuppressants
• validation

A study of 50 paediatric renal transplant recipients found that a validated VAMS LC-MS/MS method for tacrolimus showed high correlation with the reference method over 0.5–60 ng/mL, with minimal haematocrit effect.

Therapeutic Drug Monitoring of Tacrolimus Based on VAMS in Renal Transplant Pediatric Recipients — LC-MS/MS Method, Hematocrit Effect, and Clinical Application — Kocur et al., Pharmaceutics · source ↗

• vams
• venous-agreement
• neoteryx-mitra
• blood
• tdm
• haematocrit
• dried
• capillary
• pediatric
• immunosuppressants
• validation