Dried plasma spot as an innovative approach to therapeutic drug monitoring of apixaban: Development and validation of a novel liquid chromatography-tandem mass spectrometry method

IF 1.9 3区 化学 Q3 BIOCHEMICAL RESEARCH METHODS Journal of Mass Spectrometry Pub Date : 2024-08-26 DOI:10.1002/jms.5081
Alessia Cafaro, Manuela Stella, Giammarco Baiardi, Sebastiano Barco, Federica Pigliasco, Roberto Bandettini, Luca Nanni, Francesca Mattioli, Giuliana Cangemi
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Abstract

Apixaban, a direct oral anticoagulant drug (DOAC), typically does not require routine therapeutic drug monitoring (TDM), yet recent guidelines propose its use in specific clinical scenarios. While various antifactor Xa (anti-FXa) chromogenic assays serve as useful proxies for measuring plasma exposure to apixaban in emergencies, they lack specificity compared with chromatographic methods. This research project is intended to the development and validation of a standardized protocol of liquid chromatography–tandem mass spectrometry (LC–MS/MS) in conformity with the ICH guidelines M10 for the measurement of apixaban in both plasma and dried plasma spots (DPSs). Samples preparation included protein precipitation after the addition of a deuterated internal standard (IS), and the chromatographic separation was carried out on a Thermo Scientific™ Accucore™ Polar Premium column (50 mm × 2.1 mm, i.d. 2.6 m). The newly developed LC–MS/MS method for apixaban mesurement from both plasma and DPS resulted linear over a wide concentration range (31.25–500 ng/mL), accurate, and reproducible without matrix effects, allowing for specific and rapid quantification. Stability was assessed on quality controls and a real sample, allowing the setting up of a robust TDM protocol that was applied to five anonymized plasma samples obtained from adult patients undergoing apixaban treatment at steady-state. In conclusion our novel LC–MS/MS method is adequate for accurate apixaban quantitation from both plasma and DPS matrixes, and may thus facilitate the guidelines suggested implementation of apixaban TDM, even in peripheral hospitals through shipment of DPS at reference laboratories.

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将干血浆点作为阿哌沙班治疗药物监测的一种创新方法:新型液相色谱-串联质谱方法的开发与验证。
阿哌沙班是一种直接口服抗凝药(DOAC),通常不需要进行常规治疗药物监测(TDM),但最近的指南建议在特定临床情况下使用阿哌沙班。虽然各种抗因子 Xa(anti-FXa)色原检测法可作为测量紧急情况下阿哌沙班血浆暴露量的有用替代方法,但与色谱法相比,它们缺乏特异性。本研究项目旨在开发和验证符合 ICH 指南 M10 的液相色谱-串联质谱(LC-MS/MS)标准化方案,用于测量血浆和干血浆斑点(DPSs)中的阿哌沙班。样品制备包括加入氚代内标(IS)后的蛋白质沉淀,色谱分离采用 Thermo Scientific™ Accucore™ Polar Premium 色谱柱(50 mm × 2.1 mm,内径 2.6 m)。新开发的 LC-MS/MS 方法可在较宽的浓度范围(31.25-500 ng/mL)内对血浆和 DPS 中的阿哌沙班进行测定,该方法线性、准确、重现性好,无基质效应,可进行特异性快速定量。在质量控制和真实样本上评估了稳定性,从而建立了一套稳健的 TDM 方案,并将其应用于从接受阿哌沙班稳态治疗的成年患者处获得的五个匿名血浆样本。总之,我们的新型 LC-MS/MS 方法足以对血浆和 DPS 基质中的阿哌沙班进行准确定量,因此有助于根据指南建议实施阿哌沙班 TDM,即使是在外围医院,也可以通过参考实验室的 DPS 运输来实现。
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来源期刊
Journal of Mass Spectrometry
Journal of Mass Spectrometry 化学-光谱学
CiteScore
5.10
自引率
0.00%
发文量
84
审稿时长
1.5 months
期刊介绍: The Journal of Mass Spectrometry publishes papers on a broad range of topics of interest to scientists working in both fundamental and applied areas involving the study of gaseous ions. The aim of JMS is to serve the scientific community with information provided and arranged to help senior investigators to better stay abreast of new discoveries and studies in their own field, to make them aware of events and developments in associated fields, and to provide students and newcomers the basic tools with which to learn fundamental and applied aspects of mass spectrometry.
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