Combining digital adherence technology and therapeutic drug monitoring for personalised tuberculosis care

Ghimire, Samiksha; Iskandar, Deni; Borg-Boekhout, Roelina van der; Zenina, Marina; Bolhuis, Mathieu S.; Kerstjens, Huib A. M.; Rossum, Marieke van; Touw, Daan; Zijp, Tanja R; Boven, Job F.M. van; Akkerman, Onno W.

doi:10.1183/13993003.01690-2022

Cited by 8 publications

(9 citation statements)

References 16 publications

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“…Notably, digital adherence technologies (DAT) increasingly support adherence interventions in TB 44 45. Besides monitoring and supporting adherence directly, combining DAT with therapeutic drug monitoring (TDM) could further aid personalised TB care 46 47. The latter, TDM, was not part of the top listed CPS activities in Indonesia; only drug therapy monitoring was more of an activity to ensure safe, effective and rational drug therapy for patients, not specifically assessing blood drug concentration.…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary tuberculosis care: leveraging the role of hospital pharmacists

Iskandar,

Pradipta,

Anggriani

et al. 2023

BMJ Open Resp Res

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IntroductionOptimal pharmacological treatment of tuberculosis (TB) requires a multidisciplinary team, yet the hospital pharmacist’s role is unclear. We aimed to analyse hospital pharmacist-provided clinical pharmacy services (CPS) implementation in TB care.MethodA nationwide survey-based online cross-sectional study was conducted on hospital pharmacists in Indonesia from 1 November 2022 to 22 November 2022. Outcomes were the extent of pharmacists’ involvement in multidisciplinary TB care, TB-related CPS provided and views on TB-related CPS. The probability of pharmacists’ involvement in multidisciplinary TB teams was assessed using logistic regression.ResultsIn total, 439 pharmacists (mean age 31.2±6.22 years, 78% female) completed the survey. Thirty-six per cent were part of multidisciplinary TB care, and 23% had TB-related tasks. Adherence monitoring (90%) and drug use evaluation (86%) were the most conducted TB-related CPS. Pharmacists’ views on TB-related CPS implementation were generally positive, except for financial incentives. Work experience (OR 1.99, 95% CI 1.09 to 3.61), ever received TB-related training (OR 3.51, 95% CI 2.03 to 6.14) and specific assignments to provide TB-related CPS (OR 8.42, 95% CI 4.99 to 14.59) significantly increased pharmacist involvement in multidisciplinary TB care.ConclusionAround one-third of hospital pharmacists are part of multidisciplinary TB care, with medication adherence and drug use monitoring as primary tasks. Pharmacists’ experience, training, assignment to provide TB-related CPS and financial incentives are key elements for further implementation in multidisciplinary TB care. Pharmacists should proactively support current TB care and conduct operational research, sharing data with healthcare peers and fostering a collaborative multidisciplinary TB care team.

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Section: Discussionmentioning

confidence: 99%

Multidisciplinary tuberculosis care: leveraging the role of hospital pharmacists

Iskandar,

Pradipta,

Anggriani

et al. 2023

BMJ Open Resp Res

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“…Nevertheless, TDM provides an additional opportunity to engage patients in their health care journey, potentially resulting in better medication adherence and improved disease management. 196 To achieve this, treating physicians should provide patients with clear instructions on monitoring schedules and dose adjustments, helping them interpret TDM results to make informed decisions.…”

Section: Patient Education and Empowerment For Selfmanagementmentioning

confidence: 99%

Best Practice for Therapeutic Drug Monitoring of Infliximab: Position Statement from the International Association of Therapeutic Drug Monitoring and Clinical Toxicology

Alsoud,

Moes,

Wang

et al. 2024

Therapeutic Drug Monitoring

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Background: Infliximab, an anti–tumor necrosis factor monoclonal antibody, has revolutionized the pharmacological management of immune-mediated inflammatory diseases (IMIDs). This position statement critically reviews and examines existing data on therapeutic drug monitoring (TDM) of infliximab in patients with IMIDs. It provides a practical guide on implementing TDM in current clinical practices and outlines priority areas for future research. Methods: The endorsing TDM of Biologics and Pharmacometrics Committees of the International Association of TDM and Clinical Toxicology collaborated to create this position statement. Results: Accumulating data support the evidence for TDM of infliximab in the treatment of inflammatory bowel diseases, with limited investigation in other IMIDs. A universal approach to TDM may not fully realize the benefits of improving therapeutic outcomes. Patients at risk for increased infliximab clearance, particularly with a proactive strategy, stand to gain the most from TDM. Personalized exposure targets based on therapeutic goals, patient phenotype, and infliximab administration route are recommended. Rapid assays and home sampling strategies offer flexibility for point-of-care TDM. Ongoing studies on model-informed precision dosing in inflammatory bowel disease will help assess the additional value of precision dosing software tools. Patient education and empowerment, and electronic health record–integrated TDM solutions will facilitate routine TDM implementation. Although optimization of therapeutic effectiveness is a primary focus, the cost-reducing potential of TDM also merits consideration. Conclusions: Successful implementation of TDM for infliximab necessitates interdisciplinary collaboration among clinicians, hospital pharmacists, and (quantitative) clinical pharmacologists to ensure an efficient research trajectory.

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“…Furthermore, patient-generated data are analyzed in real-time to monitor the treatment progress and detect potential deviations from the treatment plan. Wearable devices coupled with mobile apps collect data on medication intake, symptom reporting, and physiological parameters, such as heart rate or respiratory function [ [162] , [163] , [164] , [165] ]. This information is subsequently processed to identify patterns or anomalies that indicate potential non-adherence or treatment response issues.…”

Section: Six Primary Prospects In Tb Clinical Managementmentioning

confidence: 99%

Push forward LC-MS-based therapeutic drug monitoring and pharmacometabolomics for anti-tuberculosis precision dosing and comprehensive clinical management

Thu,

Tien,

Yen

et al. 2024

Journal of Pharmaceutical Analysis

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Combining digital adherence technology and therapeutic drug monitoring for personalised tuberculosis care

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Cited by 8 publications

References 16 publications

Multidisciplinary tuberculosis care: leveraging the role of hospital pharmacists

Multidisciplinary tuberculosis care: leveraging the role of hospital pharmacists

Best Practice for Therapeutic Drug Monitoring of Infliximab: Position Statement from the International Association of Therapeutic Drug Monitoring and Clinical Toxicology

Push forward LC-MS-based therapeutic drug monitoring and pharmacometabolomics for anti-tuberculosis precision dosing and comprehensive clinical management

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