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Fifth International CongressDrug Therapy in HIV Infection22-26 October, 2000
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THERAPEUTIC DRUG MONITORING
D.M. Burger
University Medical Centre Nijmegen, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
Int Cong Drug Therapy HIV 2000 Oct 22-26;5:Abstract No.
AIDS 2000, Oct 22-26;14(Suppl. 4); S10
In general, therapeutic drug monitoring (TDM) is indicated when the following criteria are met: (1) there is a large interindividual vatiation in drug levels in patients receiving the same dose; (2) there is a relationship between the drug level and effect (therapeutic or toxic); (3) there is a narrow therapeutic window; (4) drug levels may reflect (partial) non-compliance
The nucleoside RT inhibitors are not a candidate for TDM because criterium 2 is not met: these drugs need to be phosphorylated intracellularly, and because there is not a clear relationship between parent drug levels in plasma and intracellular triphosphates, TDM of nucleoside RT inhibitors is meaningless.
This is different for non-nucleoside RT inhibitors and the protease inhibitors. Especially for the protease inhibitors relationships between plasma levels and therapeutic effect have been described by several groups. Few studies relating toxicity with drug levels of protease inhibitors have been conducted. A therapeutic window of the protease inhibitors has not yet been established, though evidence is accumulating that this window can be determined. Finally, studies are ongoing to assess the value of TDM in compliance research.
Data on the use of TDM of non-nucleoside RT inhibitors are still sparse. The first studies have shown relationships between drug levels and virological failure.
Based on the above arguments, TDM, especially for the protease inhibitors, appears indicated. Some argue that controlled clinical trials need to demonstrate a clinical benefit of TDM before it can be recommended as standard care, while others already use it in their routine patient management. Pros and cons of TDM will be discussed.
Presenting author: D.M. Burger
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2000-10-22
Originally published in AIDS Volume 14, Supplement 4 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701
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