2024 · Journal of pharmaceutical and biomedical analysis · paywalled
Fingerprick volumetric absorptive microsampling for therapeutic drug monitoring of antiseizure medications: Reliability and real-life feasibility in epilepsy patients
Cancellerini et al.
The finding, in our words
A study of 301 adults with epilepsy providing 464 measurements found that patient-centric capillary VAMS microsampling showed good agreement with plasma for seven of 13 antiseizure medicines, such as carbamazepine and levetiracetam. However, systematic differences remained for valproate, primidone, topiramate, and zonisamide, meaning decentralised monitoring is feasible for most but some drugs need further evaluation.
A paraphrase to the Library’s standard, never the abstract. The source is one link away and is always the authority.
In AML and CLL, 91% of VAMS venetoclax results fell within 20% of plasma after individualised haematocrit correction; in home sampling, 18 of 21 patients self-sampled independently and 76% of returned samples were analysable, which shows home microsampling is workable, though the authors ask for multicentre validation.
At-home volumetric absorptive microsampling (VAMS) for anti-seizure medicines was feasible and reliable, with strong correlations to clinic VAMS and low bias for lacosamide, lamotrigine and levetiracetam; quantitative dried blood spot (qDBS) was a reliable alternative in the ambulatory setting, though older age reduced sampling quality.
This study established conversion methods for estimating plasma concentrations from whole blood VAMS samples for seven out of ten oral anticancer drugs, finding good agreement between capillary and venous samples. Patients reported a positive experience with home sampling using this microsampling technique.
Microsampling, particularly VAMS and quantitative DBS, can enable patient-centric therapeutic drug monitoring of immunosuppressants after transplantation, allowing home self-sampling and long-term monitoring when patients live far from transplant centres. These volumetric dried formats have largely overcome the haematocrit effect and sample heterogeneity that limit conventional dried blood spots.
VAMS microsampling found no significant difference from venous blood for tacrolimus in paediatric patients; samples were stable for 14 days, with average difference between paired at-home samples of 0.12 ± 0.94 ng/mL.