Eight Drugs a Week Podcast

This episode is about the TDM of biologics, a therapeutic class that only really emerged into widespread use about 20 years ago – but that as a class represents a breakthrough for many therapeutic challenges. This area has some differences compared to traditional TDM of small molecules, and although it’s established for some biologics, the role for TDM in the space is, in a sense, still being determined. Florian has consequently titled this episode ‘Tomorrow never knows’ – a great song and a fitting title.

Our guests today are Annick de Vries and Murray Barclay, and both have made important contributions in the space. Once again, our guests coincided on their favourite Beatle – one that we haven’t heard mentioned in previous episodes!

In this episode we hear about:

• the differences between small molecule drugs and biologics, and the implications this has for TDM of the latter
• how disease severity may influence pharmacodynamics, and ultimately how we might ultimately select treatment targets despite challenges in obtaining measurements of disease activity
• anti-drug antibodies and the role of TDM there
• disease dependent clearance and whether concentrations of biologics might possibly be a marker of disease activity

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.

To join IATDMCT, visit https://www.iatdmct.org/member-join

Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests:

Annick de Vries is director of Diagnostic Services at Sanquin in Amsterdam, The Netherlands. Sanquin is a not-for-profit that provides blood products nationwide, but also develop specialized pharmaceutical products and provide diagnostic services. She is the current chair of the IATDMCT Biologics Committee.

Murray Barclay is a clinical pharmacologist and a gastroenterologist at Christchurch Hospital in New Zealand, and a Clinical Professor at the University of Otago. Murray was the previous chair of the Biologics Committee.

This time, it’s the right time - not a second time, but a unique time - to take the road to Banff, Canada, for the 22nd edition of the IATDMCT annual congress.

This time, following a very successful virtual edition in 2020, we are very glad to be meeting in person. And what a place to meet! - surrounded by Banff’s mountainous splendour. We are so grateful the congress organizing committee accepted the mission to make the show happen again, and we acknowledge the incredible work they’ve put behind two wonderful congresses.

We hope attendees will be inspired by the location, and we are certain it will be a very special IATDMCT meeting this year.

Joining us for the episode are organising committee heroes, congress chairs David Kinniburgh and Penny Colbourne, and Pamela Lyons, who apart from being an event organising extraordinaire, is also IATDMCT member manager, and runs our head office!

In this episode we’ll hear ab-oo-t (pun intended!):

• How the congress theme ties in with Banff's history of exploration and beautiful mountain scenery.

• How the scientific program balances traditional topics with new frontiers in TDM and CT: wastewater testing for drug use, pioneering genetic testing and AI applications, developments in keeping abreast of novel psychoactive substances.

• The pre-congress workshop on emerging topics in clinical toxicology, including novel drug checking services and lessons learned following marijuana legalization.

• The social program that ensures guests will be fully immersed in the Canadian Rockies experience, including hiking opportunities, a western-themed dinner, and wildlife spotting

• Why inspiration, creative insight and joyful collaboration are essentially guaranteed at this meeting!

About our guests:

Dave is the Director of the Alberta Centre for Toxicology, an Adjunct Associate Professor at the Cumming School of Medicine of the University of Calgary, and a Clinical Professor at the University of Alberta, located in Edmonton, Alberta.

Penny is a Clinical Toxicologist at the University of Alberta Hospital and Clinical Professor at the University of Alberta.

Pam started at IATDMCT in 1995, with our Congress in Vienna. She’s attended every Congress since! She takes care of our members and provides support to our senior leadership teams. Pam and the IATDMCT team are based at our head office in Kingston, Ontario.

There was a time when we performed laborious pharmacokinetic hand calculations to tailor drug dosages and regimens – a practice that can still be useful for those brave enough to perform logarithmic calculator manipulations. These days, we are fortunate to have an increasing number of software tools to help us with the task, however many rely on population pharmacokinetic models typically built with relatively small data sets, and often necessarily representing subpopulations with niche requirements. Tomorrow, our work will no doubt be helped by artificial intelligence and machine learning approaches, and we have already started to see such approaches applied in the research arena.

Today, we are lucky to be joined by two experts from the field of pharmacokinetic and pharmacodynamic modelling, Prof Michael Neely and Prof Jean-Baptiste Woillard.

In this episode we’ll hear about:

• the differences between traditional population pharmacokinetics and machine learning approaches in predicting drug exposure and optimizing dosing regimens

• some advantages of ML approaches, including in handling nonlinear patterns

• the challenge of interpretability of results and dose recommendations from machine learning methods compared to traditional pharmacokinetic methods

• which clinical contexts we will soon see machine learning derived models applied to clinical care

• the future of modelling and machine learning in pharmacology, including ethical considerations and the concept of augmented intelligence

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.

To join IATDMCT, visit: https://iatdmct.org/join-us/

Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests:

Jean-Baptiste is a Professor of Clinical Pharmacology in the Department of Pharmacology, Toxicology and Pharmacovigilance in the Limoges University Hospital, France where he leads the Pharmacometrics and Artificial Intelligence hospital functional unit. He is also Deputy Director of the Inserm Unit 1248 at the University of Limoges, France.

Michael Neely is a Professor of Pediatrics at the Keck School of Medicine of the University of Southern California, Chief of the Division of Infectious Diseases and Director of the Laboratory of Applied Pharmacokinetics and Bioinformatics, both at the Children’s Hospital Los Angeles.

This episode we're excited to introduce you to the young guns, the bright minds of the Young Scientist Committee of the IATDMCT, who are making waves in this ever-evolving field.

Our guests are Lea Wagmann, Hualin Cai, and Sumith Mathew, each bringing their unique perspectives and experiences from Germany, China, and India, respectively. From their early inspirations to their current endeavours, we'll uncover what drives them and the impact they're making on the future of pharmacology and toxicology. We’ll delve into their expectations for the years ahead, exploring the forefront of the scene and the innovative ideas brewing within the young scientist community.

In this episode we’ll hear about:

• Very interesting science each one is working on including quantification to support evaluation of compliance, a suite of modelling tools being applied in the resource limited setting, and the impact of the microbiome on psychopharmacology

• First congress experiences: meeting professional heroes and memorable moments

• How membership has enabled mentoring opportunities with some of the greats in the field

• Facing challenges such as lack of evidence for many drugs and wider need for education and training - and what YS are doing to address these

• YS involvement in initiatives such as the recently launched Regional Asian Pacific Section of the Association, and opportunities for support and mentorship in the region

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.

To join IATDMCT, visit https://www.iatdmct.org/member-join

Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests:

Lea Wagmann is a Clinical Toxicologist and postdoctoral researcher at the Department of Experimental and Clinical Toxicology of the Saarland University in Homburg, Germany.

Hualin Cai is an Associate Professor of Neuropsychopharmacology and Clinical Toxicology, the Department of Pharmacy and Institute of Clinical Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, China

Sumith Mathew is an Associate Professor of Pharmacology and Clinical Pharmacology at Christian Medical College, Vellore, India.

This episode is about a fairly recent development in TDM and clinical toxicology that has huge potential, which has actually been used for many decades. It was recently the 50th anniversary of the Guthrie method, where dried blood spots are used to screen inborn errors of metabolism in neonatal infants. Thanks to instrumental developments, dried blood spots, and more generally microsampling approaches, have been increasingly applied to quantify a wide range of drug entities. Although these approaches offer plenty of novel opportunities in our field, they are not without challenges and pitfalls.

Our guests today are two of the biggest names in microsampling – and also absolute IATDMCT VIPs and legends. We are joined by our current president, Jan-Willem Alffenaar, and president-elect, Christophe Stove, for deep dive on the topic.

In this episode we hear about:

• Which Beatle might be the most interesting test subject for microsampling evaluation

• How low can you go? When does it become a macrosample?

• Diverse microsampling approaches: dry, wet, different matrices

• Go robust – or go home

• Obvious, and not-so-obvious challenges; typical and very novel solutions

• Clinical, toxicological and research applications: what the innovators are doing, and potential for even greater global impact

• How many times would you prick your finger in a day? The sweet spot in being informative, but not terrible for patients

• From the Beatles to ABBA: money, money, money and the place of microsapmpling in health systems

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.

To join IATDMCT, visit https://www.iatdmct.org/member-join

Subscribe to Eight Drugs a Week on your preferred podcast platform.

About our guests:

Jan-Willem is Professor of Clinical Pharmacology at The University of Sydney, and Chair of Clinical Pharmacy at Westmead Hospital, in Sydney Australia.

Christophe Stove is Professor, and director of the toxicology laboratory, at the Department of Bioanalysis, at Gent University in Belgium.