Survey on the Development of Therapeutic Drug Monitoring in Chinese Hospitals in 2018
LI Shu1, ZHANG Qian2, ZHANG Shuang2, CHEN Wen-qian1, ZHANG Xiang-lin1*
1. Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, China; 2. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
Abstract:OBJECTIVE To understand the development of therapeutic drug monitoring (TDM) in domestic hospitals and provide guidance for disciplinary development. METHODS A range of professions involved in 7 aspects (33 questions) of TDM were surveyed by questionnaire on WeChat in late 2018. Information gathered included: basic information, development of TDM laboratories and clinical departments, monitoring drug types and quantity, quality control, interpretation of reports and individual drug regimen, and approval and management. These data were exported in Excel, and the valid data were included. RESULTS Five hundred and four responses were received, of which 463 were valid and included, of which 177 hospitals developed TDM. The results of the above 7 aspects which were from those 177 hospitals in 2018 were summarized as follows. The educational backgrounds were mainly the master degree (43%) and the bachelor degree (33%). Most hospitals (75%) established chromatographic methods. The monitoring items were mainly blood drug concentration test(63%) and drug genetic testing (36%). In all clinical departments, TDM was most applied in Neurology. Eleven categories of drugs applying TDM in 2018 were investigated, of which psychotic drugs with the most varieties included eighteen drugs, and immunosuppressive agents had the most samples monitoring (57%). Over one half of hospital (64%) carried out the quality control. Only one half of hospitals (89/177) developed clinical interpretation, of which 75% showed that clinical pharmacists participated in the interpretation; 82% developed individualized plans based on the results. Most hospitals (65%) carried out the TDM review and the systems of examination and approval, and TDM in 47% of the hospitals was included in the hospital pharmacy management and drug therapy committee management system. CONCLUSION This survey has obtained information of the seven aspects, and has mastered the TDM profile of 11 categories of drugs in 2018. However, there is still insufficient development in the quality control, clinical interpretation, individualized regimen development and TDM management. In addition to conducting drug monitoring, TDM work in the future will focus on improving and developing the above deficiencies and promoting clinical rational drug use.
李沭, 张倩, 张爽, 陈文倩, 张相林. 2018年中国医院治疗药物监测开展状况调查[J]. 中国药学杂志, 2019, 54(24): 2087-2092.
LI Shu, ZHANG Qian, ZHANG Shuang, CHEN Wen-qian, ZHANG Xiang-lin. Survey on the Development of Therapeutic Drug Monitoring in Chinese Hospitals in 2018. Chinese Pharmaceutical Journal, 2019, 54(24): 2087-2092.
LAN J. Overview of therapeutic drug monitoring and research progress[J]. Tianjin Pharm(天津药学), 2010, 22(3):53-55.
[2]
LI Z F, QIN X. Advances in researches on therapeutic drug monitoring of clinically commonly used drugs[J]. Chin J Rat Drug Use(中国合理用药探索), 2018, 15(10):77-80.
[3]
ZHANG S C, CHEN Z X, HUANG Q Y, et al. Analysis of the development status of neuropsychiatric therapeutic drug monitoring in terms of the external quality evaluation[J]. J China Pharm(中国药房), 2019(1):136-140.
[4]
LING S S.New Theory and Methods for Therapeutic Drug Monitoring(治疗药物监测新理论与新方法)[M]. Vol 10. Beijing: China Medical Science Press, 2002:209-241.
[5]
WU Z G, REN S H, CAI M H. A study on digoxin pharmacokinetics in elderly patients with congestive heart failure[J]. J Jinling Hosp(金陵医院学报), 1997, 10(2):116-118.
[6]
NORRIS R L, MARTIN J H, THOMPSON E, et al. Current status of therapeutic drug monitoring in Australia and New Zealand: a need for improved assay evaluation, best practice guidelines, and professional development [J]. Ther Drug Monit, 2010, 32(5): 615-623.
[7]
GUO W, GUO G X, SUN C, et al. Therapeutic drug monitoring of psychotropic drugs in China: a nationwide survey[J]. Ther Drug Monit, 2013, 35(6):816-822.
[8]
BO N N, WANG Q, LIU X. Research on the progress of technology on therapeuticdrug monitoring[J]. Int J Lab Med(国际检验医学杂志), 2015, 36(22):3291-3294.
[9]
ZHANG S J, SUN H W, GUO J J, et al. Quantitative determination of five azole antifungals in human serum by LC-MS/MS and its application to therapeutic drug monitoring[J]. Chin J Pharm Anal(药物分析杂志), 2017, 37(6):1038-1045.
[10]
WANG X X, CHEN W Q, KONG X D, et al. Quantification of imipenem and meropenem in human plasma by UPLC-MS/MS and its application in therapeutic drug monitoring[J]. Chin Pharm J(中国药学杂志), 2018, 53(3):218-222.
[11]
WANG Z G, SHEN X B. Introduction to therapeutic drug monitoring [J]. Foreign Med Sci Sect Pharm(国外医学药学分册), 1981, 2: 88-91.
[12]
CHEN W Q, CUI G, LIU X, et al. Simultaneous determination of cyclosprine A, tacrolimus, sirolimus, mycophenolic acid, and prednisolone by UPLC-MS/MS[J]. Chin Pharm J(中国药学杂志), 2014, 49(20):1845-1849.
[13]
ZHANG Y, ZHANG R. Recent advances in analytical methods for the therapeutic drug monitoring of immunosuppressive drugs [J]. Drug Test Anal, 2018, 10(1): 81-94.
[14]
ZHU R F, DING X L, LIAO L Y. Advances in therapeutic drug monitoring of monoclonal antibody drugs[J]. Chin Pharm J(中国药学杂志), 2018, 53(20):1714-1717.
[15]
YE Z K, CHEN Y L, CHEN K, et al. Therapeutic drug monitoring of vancomycin: a guideline of the division of therapeutic drug monitoring, Chinese pharmacological society[J]. J Antimicrob Chemother, 2016, 71(11):3020-3025.
[16]
ZHAI S D, HE B, WANG R, et al. Expert consensus on the therapeutic drug monitoring of vancomycin in China[J]. Chin J Clin Pharmacol(中国临床药理学杂志), 2016, 32(17):1633-1636.
[17]
CHEN Y, ZHU M, WANG X Y, et al. Analysis of clinical administration behavior of vancomycin under clinical pharmacy intervention[J]. Chin J Drug Appl Monit(中国药物应用与监测), 2018, 15(5):295-297, 318.
[18]
WONG G, BRINKMAN A, BENEFIELD R J, et al. An international, multicentre survey of beta-lactam antibiotic therapeutic drug monitoring practice in intensive care units [J]. J Antim Chemother, 2014, 69(5): 1416-1423.
[19]
TAO L Y, ZENG Y. Discussion on pharmaceutical care that pharmacistparticipation in the antiepileptictreatment drug monitoring[J]. Pract Pharm Clin Remed(实用药物与临床), 2014, 17(2): 209-211.
[20]
WANG Y M, YIN W M, ZHANG X L, et al. Clinical pharmacy practice oriented to therapeutic drug monitoring[J]. China Higher Med Edu(中国高等医学教育), 2018,(5):136-138.