The steps to therapeutic drug monitoring : a structured approach illustrated with imatinib

Buclin, Thierry (Service of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland) ; Thoma, Yann (School of Management and Engineering Vaud, HES-SO // University of Applied Sciences Western Switzerland) ; Widmer, Nicolas (Service of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland ; Pharmacy of Eastern Vaud Hospitals, Rennaz, Switzerland ; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland) ; André, Pascal (Service of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland) ; Guidi, Monia (Service of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland ; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland) ; Csajka, Chantal (Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland ; Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland) ; Decosterd, Laurent A. (Service of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland)

Pharmacometric methods have hugely benefited from progress in analytical and computer sciences during the past decades, and play nowadays a central role in the clinical development of new medicinal drugs. It is time that these methods translate into patient care through therapeutic drug monitoring (TDM), due to become a mainstay of precision medicine no less than genomic approaches to control variability in drug response and improve the efficacy and safety of treatments. In this review, we make the case for structuring TDM development along five generic questions: 1) Is the concerned drug a candidate to TDM? 2) What is the normal range for the drug's concentration? 3) What is the therapeutic target for the drug's concentration? 4) How to adjust the dosage of the drug to drive concentrations close to target? 5) Does evidence support the usefulness of TDM for this drug? We exemplify this approach through an overview of our development of the TDM of imatinib, the very first targeted anticancer agent. We express our position that a similar story shall apply to other drugs in this class, as well as to a wide range of treatments critical for the control of various life-threatening conditions. Despite hurdles that still jeopardize progress in TDM, there is no doubt that upcoming technological advances will shape and foster many innovative therapeutic monitoring methods.


Keywords:
Article Type:
scientifique
Faculty:
Ingénierie et Architecture
School:
HEIG-VD
Institute:
ReDS - Reconfigurable & embedded Digital Systems
Date:
2020-03
Pagination:
10 p.
Published in:
Frontiers in Pharmacology
Numeration (vol. no.):
2020, vol. 11, no. 177
DOI:
ISSN:
1663-9812
Appears in Collection:



 Record created 2020-03-25, last modified 2020-10-27

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