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Ialongo C, Sapio M, Angeloni A. Analytical Performance of the New Siemens Affinity Chrome-Mediated Immunoassay Everolimus Assay and Its Interchangeability With the Thermo Quantitative Microsphere System for Routine Therapeutic Drug Monitoring of Patients After Solid Organ Transplantation. Ther Drug Monit 2023; 45:217-222. [PMID: 36920504 DOI: 10.1097/ftd.0000000000001009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND A new homogeneous affinity chrome-mediated immunoassay (ACMIA) "EVRO" from Siemens Healthcare was evaluated for therapeutic drug monitoring of everolimus (EVL) with automated sample pretreatment and compared with quantitative microsphere system (QMS) "EVER" from Thermo Fisher Scientific. METHODS Imprecision, inaccuracy, and limit of quantitation (LoQ) of ACMIA/EVRO were verified using both hemolysate quality control (QC) samples and pooled whole blood specimens. The interchangeability of methods and the agreement of results were analyzed using 72 specimens (from 38, 30, and 4 kidney, liver, and lung transplant recipients, respectively). RESULTS Within-run imprecision ranged within %CV = 2.81-2.53 with pooled whole blood specimens and within %CV = 2.88-2.53 with QCs; total imprecision with QCs was within %CV = 2.14-1.51. Inaccuracy with value assigned QC was %△ = 5.36 at the 5.6 ng/mL level and %△ = 5.56 at the 11.7 ng/mL level. LoQ was 0.93 ng/mL (%CV = 10). Passing-Bablok regression showed a constant bias of 0.679 ng/mL (95% CI: 0.216-1.026) and a proportional bias of 1.326 (95% CI: 1.240-1.425). Bland-Altman analysis showed 5/72 (6.9%) paired differences exceeding the limits of agreement and 1/72 (1.4%) paired differences exceeding 1.96 SD to a combined bias of 39.9% after detrending. CONCLUSIONS ACMIA/EVRO shows satisfactory analytical performances that comply with recommendations, but it does not fulfill requirements for interchangeability with QMS/EVER. Particularly, this new assay using sirolimus-specific antibody shows a sizable proportional bias versus the more specific comparator, which may be because of EVL metabolites. This is supported by the lack of agreement for individual differences in most samples collected at the peak concentration (C2). Therefore, further evidence is needed to support the transition of EVL level monitoring from QMS/EVER to ACMIA/EVRO without making extensive changes to both reference interval and patient's baseline.
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Affiliation(s)
- Cristiano Ialongo
- Department of Experimental Medicine, Policlinico Umberto I, "Sapienza" University, Rome, Italy
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Ialongo C, D'alessandro A, Sapio M, Angeloni A, Porzio O. Evaluation of the interchangeability between the new fully-automated affinity chrome-mediated immunoassay (ACMIA) and the Quantitative Microsphere System (QMS) with a CE-IVD-certified LC-MS/MS assay for therapeutic drug monitoring of everolimus after solid organ transplantation. Clin Chem Lab Med 2023; 61:245-250. [PMID: 36330751 DOI: 10.1515/cclm-2022-0699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aims to evaluate the interchangeability between the Siemens Healthineers' "EVRO" new affinity chrome-mediated immunoassay (ACMIA/EVRO) and Thermo Fisher Scientific's "EVER" Quantitative Microsphere System (QMS/EVER) with Chromsystems' CE-IVD-certified "MassTox" liquid-chromatography/tandem-mass spectrometry (LC-MS/MS) assay for the therapeutic drug monitoring of everolimus. METHODS A single lot of reagent, calibrators and controls were used for each assay. A total of 67 whole blood samples (n=67) from patients receiving solid organ transplant were analyzed (n=31 with kidney transplant and n=36 with liver transplant); Passing-Bablok regression and Bland-Altman difference plot were used to evaluate bias and individual agreement; LC-MS/MS analysis was used to measure the actual concentrations of calibrators and controls compared to the assigned value. RESULTS ACMIA/EVRO did not show any systematic bias compared to LC-MS/MS (intercept=0.244 ng/mL, 95% CI: -0.254 to 0.651 ng/mL). Nevertheless, significant proportional bias (slope=1.511, 95% CI: 1.420 to 1.619) associated to a combined bias of 44.8% (95% CI: 41.2-48.3%) was observed. Conversely, QMS/EVER did not show any bias at both systematic (intercept=-0.151 ng/mL, 95% CI: -0.671 to 0.256 ng/mL) and proportional level (slope=0.971, 95% CI: 0.895 to 1.074) with a non-statistically significant combined bias of -3.6% (95% CI: -8.4-1.1%). Based on a concentration of calibrators and controls above the assigned value for both the analytical methods, in the ACMIA/EVRO a correction which was approximately one-third of the correction for the QMS/EVER was observed. CONCLUSIONS ACMIA/EVRO but not QMS/EVER shows a lack of interchangeability with the CE-IVD-certified LC-MS/MS assay. We hypothesize that, as the ACMIA/EVRO uses an anti-sirolimus antibody, the under-corrected assigned value in the assay calibrators was not sufficient to reproduce the everolimus metabolites cross-reactivity occurring in real samples.
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Affiliation(s)
- Cristiano Ialongo
- Department of Experimental Medicine, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | | | - Maria Sapio
- Department of Experimental Medicine, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Antonio Angeloni
- Department of Experimental Medicine, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Ottavia Porzio
- Clinical Biochemistry Laboratory, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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Size exclusion chromatography: An effective tool for the estimation of Sirolimus levels. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1156:122303. [DOI: 10.1016/j.jchromb.2020.122303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/21/2020] [Accepted: 08/04/2020] [Indexed: 12/25/2022]
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Stove V, Ramos PA, Wallemacq P, Vogeser M, Schuetzenmeister A, Schmiedel C, Shipkova M. Measurement of sirolimus concentrations in human blood using an automated electrochemiluminescence immunoassay (ECLIA): a multicenter evaluation. Clin Chem Lab Med 2019; 56:764-775. [PMID: 29206642 DOI: 10.1515/cclm-2017-0583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/28/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) of sirolimus is essential in transplant recipients. We evaluated the performance of a new electrochemiluminescence immunoassay (ECLIA) for measuring sirolimus concentrations in whole blood at five European laboratories. METHODS Study assessments included repeatability, intermediate precision and functional sensitivity (concentration at coefficient of variation [CV] of 20%) experiments. Method comparisons with liquid chromatography-tandem mass spectrometry (LC-MS/MS; reference method) and two immunoassays (chemiluminescent microparticle immunoassay [CMIA] and antibody-conjugated magnetic immunoassay [ACMIA]) were performed using native samples from patients with kidney transplants. RESULTS Imprecision testing CVs were ≤6.4% and ≤10.7% across the sirolimus concentration range for both repeatability and intermediate precision, respectively. The ECLIA showed excellent functional sensitivity: the CV did not reach 20%; the CV at the assay's limit of quantitation (1.5 μg/L) was 7.0%. Agreement between the ECLIA and LC-MS/MS using native kidney samples was close, with weighted Deming regression analysis yielding a slope of 1.05, an intercept of 0.154 μg/L and a Pearson's correlation coefficient (r) of 0.94, while Bland-Altman analysis showed a combined mean bias of 0.41 μg/L (±2 standard deviation [SD], -1.96 to 2.68). The ECLIA also showed good correlation with the two other immunoassays: the CMIA (slope=0.91, intercept=0.112 μg/L and r=0.89) and the ACMIA (slope=0.99, intercept=0.319 μg/L and r=0.97). CONCLUSIONS The ECLIA showed good precision, functional sensitivity and agreement with other methods of sirolimus measurement used in clinical practice, suggesting that the assay is suitable for TDM in transplant recipients and provides an alternative to LC-MS/MS.
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Affiliation(s)
- Veronique Stove
- Clinical Biologist, Department of Laboratory Medicine, Ghent University and Ghent University Hospital, De Pintelaan 185, Ghent, Belgium
| | - Pedro Alía Ramos
- IDIBELL - Bellvitge Biomedical Research Institute, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Michael Vogeser
- Institute of Laboratory Medicine, Hospital of the University of Munich, Munich, Germany
| | | | | | - Maria Shipkova
- Central Institute for Laboratory Medicine and Clinical Chemistry, Klinikum-Stuttgart, Stuttgart, Germany
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Bowen R, Rieta R, Joshi R, Lee RC. Falsely high sirolimus concentrations due to everolimus cross-reactivity in the Siemens sirolimus immunoassay: Corrective actions implemented. Clin Chim Acta 2019; 489:162-163. [DOI: 10.1016/j.cca.2017.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022]
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Capone D, Cataldi M, Guida B, Mosca T, Tarantino G. Comparison of the everolimus concentrations measured in whole blood with everolimus QMS or sirolimus CMIA. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:275-280. [PMID: 29575933 DOI: 10.1080/00365513.2018.1455131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Few years ago, it was proposed that everolimus blood levels could be determined with the commercially available sirolimus chemiluminescence magnetic microparticle immunoassay (CMIA). More recently, a highly specific microsphere system (QMS) has been approved by FDA for therapeutic drug monitoring in humans. Aim of the present study was to compare the results of everolimus assay performed with everolimus QMS and with sirolimus CMIA. The two methods were compared with Passing-Bablok regression and Bland-Altman plot analysis. The Passing-Bablok regression analysis showed that although the results obtained with the two techniques were significantly correlated, CMIA-measured differed from QMS-measured everolimus concentrations by both a systematic and a proportional error. Specifically, at blood levels lower than 5 ng/mL CMIA were lower than QMS-measured everolimus concentrations. On the opposite, at everolimus blood concentrations higher than 10 ng/mL CMIA-estimated values became progressively higher than QMS-measured everolimus concentrations. The analysis of the Bland Altman plot showed a less than optimal agreement of the two tests (5.59% of the data point outside the ±1.96 SD interval). Moreover, the relationship between the difference between EveroQMS and EveroCMIA and their average was clearly concentration dependent with positive and negative values at concentration values lower and higher than 5 ng/mL respectively. In conclusion, our finding showed that the values of everolimus concentrations measured with sirolimus CMIA differ from those detected with the FDA-approved everolimus QMS further suggesting that sirolimus CMIA should not be used anymore for everolimus therapeutic drug monitoring.
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Affiliation(s)
- Domenico Capone
- a Integrated Care Department of Clinical Neurosciences, Anestesiology and Drug-Use, Section of Clinical Pharmacology , "Federico II" University , Naples , Italy
| | - Mauro Cataldi
- a Integrated Care Department of Clinical Neurosciences, Anestesiology and Drug-Use, Section of Clinical Pharmacology , "Federico II" University , Naples , Italy.,b Division of Pharmacology, Department of Neuroscience, Reproductive and Odontostomatologic Sciences , Federico II University , Naples , Italy
| | - Bruna Guida
- c Division of Physiology, Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy
| | - Teresa Mosca
- a Integrated Care Department of Clinical Neurosciences, Anestesiology and Drug-Use, Section of Clinical Pharmacology , "Federico II" University , Naples , Italy
| | - Giovanni Tarantino
- d Department of Clinical Medicine and Surgery , "Federico II" University , Naples , Italy
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Abstract
In 2014, the Immunosuppressive Drugs Scientific Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology called a meeting of international experts to provide recommendations to guide therapeutic drug monitoring (TDM) of everolimus (EVR) and its optimal use in clinical practice. EVR is a potent inhibitor of the mammalian target of rapamycin, approved for the prevention of organ transplant rejection and for the treatment of various types of cancer and tuberous sclerosis complex. EVR fulfills the prerequisites for TDM, having a narrow therapeutic range, high interindividual pharmacokinetic variability, and established drug exposure-response relationships. EVR trough concentrations (C0) demonstrate a good relationship with overall exposure, providing a simple and reliable index for TDM. Whole-blood samples should be used for measurement of EVR C0, and sampling times should be standardized to occur within 1 hour before the next dose, which should be taken at the same time everyday and preferably without food. In transplantation settings, EVR should be generally targeted to a C0 of 3-8 ng/mL when used in combination with other immunosuppressive drugs (calcineurin inhibitors and glucocorticoids); in calcineurin inhibitor-free regimens, the EVR target C0 range should be 6-10 ng/mL. Further studies are required to determine the clinical utility of TDM in nontransplantation settings. The choice of analytical method and differences between methods should be carefully considered when determining EVR concentrations, and when comparing and interpreting clinical trial outcomes. At present, a fully validated liquid chromatography tandem mass spectrometry assay is the preferred method for determination of EVR C0, with a lower limit of quantification close to 1 ng/mL. Use of certified commercially available whole-blood calibrators to avoid calibration bias and participation in external proficiency-testing programs to allow continuous cross-validation and proof of analytical quality are highly recommended. Development of alternative assays to facilitate on-site measurement of EVR C0 is encouraged.
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Hermida-Cadahia EF, Tutor JC. Determination of everolimus in blood samples from kidney and liver transplant recipients using the sirolimus chemiluminescence magnetic microparticle immunoassay (CMIA) on the Architect-i1000® System. Scandinavian Journal of Clinical and Laboratory Investigation 2012; 72:180-3. [DOI: 10.3109/00365513.2011.646300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Carvalho C, Coentrão L, Bustorff M, Patrício E, Sampaio S, Santos J, Oliveira G, Pestana M. Conversion from sirolimus to everolimus in kidney transplant recipients receiving a calcineurin-free regimen. Clin Transplant 2011; 25:E401-5. [PMID: 21457330 DOI: 10.1111/j.1399-0012.2011.01446.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Everolimus (EVL) and sirolimus (SRL) were introduced into immunosuppressive regimens, in an attempt to replace or reduce the dose of the nephrotoxic calcineurin inhibitors (CNI). In our institution, due to an administrative decision, conversion from SRL to EVL, was carried out, providing us the opportunity to investigate the effectiveness and safety profile of both drugs and to review the practical conversion dose between them. METHODS We retrospectively analyzed the medical records of 51 maintenance kidney transplant recipients receiving an SRL-based CNI-free regimen, who were switched to EVL. SRL dose was concentration controlled to a through level of 4-8 ng/mL. Patients were converted to a variable dose of EVL that was adjusted to achieve a trough concentration of 3-8 ng/mL. RESULTS SRL mean dose at time of conversion was 2.0 ± 0.9 mg/d. Initial EVL mean dose was 1.3 ± 0.5 mg/d. Six months after conversion, mean EVL trough level was 6.2 ± 2.8 ng/mL. EVL dose at this point was 2.0 ± 0.9 mg/d, which was not statistically different from SRL dose at the time of conversion (p = 0.575), suggesting a conversion factor of 1:1. During this six month period post conversion, no significant changes were observed in serum creatinine, hematocrit level, platelet count, proteinuria or lipid levels. No patient experienced an acute rejection episode. CONCLUSIONS Conversion from SRL to EVL in renal transplant recipients receiving a CNI-free immunosuppressive regimen can be performed safely with a low trough level range of EVL. We report for the first time a conversion factor between SRL and EVL.
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Affiliation(s)
- Catarina Carvalho
- Nephrology Research and Development Unit, Faculty of Medicine, Hospital S. João, Porto, Portugal.
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Vethe NT, Gjerdalen LC, Bergan S. Determination of cyclosporine, tacrolimus, sirolimus and everolimus by liquid chromatography coupled to electrospray ionization and tandem mass spectrometry: assessment of matrix effects and assay performance. Scandinavian Journal of Clinical and Laboratory Investigation 2010; 70:583-91. [PMID: 21039189 DOI: 10.3109/00365513.2010.531141] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The immunosuppressants cyclosporine, tacrolimus, sirolimus and everolimus are used in rejection prophylaxis after transplantation. Liquid chromatography tandem mass spectrometry (LC-MS/MS) has become a widely used methodology for monitoring of the drug levels to ensure therapeutic exposure. The main objective of the study was to evaluate the existence and potential influence of matrix effects on LC-MS/MS measurements of the immunosuppressants in clinical blood samples. METHODS The samples were prepared by protein precipitation and thereafter analysed by reversed-phase chromatography coupled to MS/MS via an electrospray interface. Assay performance including within- and between-series imprecision and deviations from external controls were examined. Elution of overall matrix components and glycerophosphocholines were investigated. The MS/MS signals were monitored in post-column infusion experiments, and post-precipitation addition of compounds provided a basis for quantification of the matrix effects. The influence of matrix effects on assay performance was investigated after dilution of quality controls with blood from multiple individuals. RESULTS Between-series coefficients of variation were ≤ 5.1, ≤ 6.6, ≤ 11.0 and ≤ 7.4 %, and the mean deviations from external controls were -10.3, -6.7, 15.6 and 4.3% for cyclosporine, tacrolimus, sirolimus and everolimus, respectively. The elution of matrix components including glycerophosphocholines overlapped to some extent with the target compounds, and the average ion suppression ranged from 8.5-21%. However, the drugs and internal standards were correspondingly influenced. CONCLUSION The internal standards consistently corrected the between-individual variability of matrix effects. These findings consolidate the reliability of the assay.
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Affiliation(s)
- Nils T Vethe
- Department of Medical Biochemistry, Oslo University Hospital, Rikshospitalet,, Oslo, Norway.
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Coentrão L, Carvalho C, Sampaio S, Oliveira J, Pestana M. Relationship Between Everolimus Blood Concentration Assessed Using the Innofluor Certican Fluorescence Polarization Immunoassay and the Architect i System Sirolimus Chemiluminescent Microparticle Immunoassay. Transplant Proc 2010; 42:1867-9. [DOI: 10.1016/j.transproceed.2010.01.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 01/25/2010] [Indexed: 10/19/2022]
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