Impact of discrepant results from clinical laboratories on patients and pharmaceutical trials: evidence from proficiency testing results

Some imminent but overlooked preanalytical and analytical challenges currently facing biomarkers and companion diagnostics

An incredibly high failure rate in the pharmaceutical industry has positioned personalized medicine with its prerequisite drug-diagnostic codevelopment, commonly known as companion diagnostics (CDx), in the frontline as an potential rescuer. This hopefulness is potentiated by the recent major advances and competitiveness in molecular diagnostics, making laboratory tests widely accessible at affordable prices. If executed correctly, biomarkers and CDx can potentially help the drug industry by enhancing the probability of success and possibly accelerating time to market; help the diagnostics industry develop tests utilizing precious, clinically annotated human samples; and, more importantly, benefit patients by supporting accurate diagnosis and selection of the most efficacious and least toxic therapies. However, this spectacular road is not yet paved, and it faces an enormous number of challenges. This paper will list these challenges and highlight some critical problems with representative examples of imminent but still overlooked preanalytical and analytical variables that can defeat the whole purpose of biomarkers and CDx and mislead drug developers and clinicians. The paper will provide some suggestions for mitigation.

Discrepant results from laboratories impact patients receiving heparin or antithrombin therapy

Despite improvements achieved in laboratory medicine over the years, discrepant results from different clinical laboratories are still a source of imminent risk to patients and the pharmaceutical industry. The problem is aggravated by a disconnect between the in vitro diagnostic community and clinicians or drug developers. This is the sequel to a previous report where data from proficiency testing, originally established as a tool for good laboratory practice, were used to highlight the size of the problem, and its possible impact on patients and pharmaceutical trials. Results from three laboratory tests commonly used as tools to monitor patients undergoing therapy with heparin or antithrombin agents, activated partial thromboplastin time, anti-factor Xa and thrombin time, were investigated. Unfortunately, data show that, owing to an absence of standardization approaches or a reasonable technique to harmonize results from different laboratories, results for the same sample, if analyzed by different laboratories or even by one laboratory employing different platforms or reagents, can be extremely different and misleading.