Ivacaftor–tezacaftor
and ivacaftor–tezacaftor–elexacaftor
are new breakthrough cystic fibrosis (CF) drug combinations that directly
modulate the activity and trafficking of the defective CF transmembrane
conductance regulator protein (CFTR) underlying the CF disease state.
Currently, in the hospital setting, there are no therapeutic drug
monitoring assays for these very expensive, albeit, life-saving drugs.
A rapid and precise novel method for the quantification of ivacaftor,
its metabolites, tezacaftor, and elexacaftor, in human plasma was
developed and validated using multiple reaction monitoring mass spectrometry
(MRM/MS). The MRM/MS analytical method was validated at a concentration
range of 0.0025–1 μg/mL for ivacaftor, ivacaftor-M1,
ivacaftor-M6, tezacaftor, and elexacaftor in human plasma. The method
displayed good accuracy (90.62–94.51%) and reproducibility
(99.91–100%) including at low concentrations 0.01 μg/mL.
With a mobile phase consisting of [acetonitrile/water]/0.1% formic
acid (70:30 v/v) at a flow rate of 0.5 mL/min, a linear correlation
was observed over a concentration range of 0.0025–1 μg/mL
in human plasma for ivacaftor (R
2 = 0.9865105),
ivacaftor-M1 (R
2 = 0.9852684), ivacaftor-M6
(R
2 = 0.9911764), tezacaftor (R
2 = 0.98742470), and elexacaftor (R
2 = 0.9897608). The reported method can accurately quantify
ivacaftor, ivacaftor-M1, ivacaftor-M6, tezacaftor, and elexacaftor
at low concentrations in human plasma. We have established a cost-efficient
and timely method for measuring ivacaftor, its metabolites, and tezacaftor
with or without elexacaftor in human plasma suitable for high-throughput
applications in the hospital settings or clinical trials.