TDM of antiretroviral drugs: The continuing story (of Bungalow Bill)…

06/01/23 • 38 min

This episode is about the TDM of antiretroviral drugs, an area with a boom in research output in the late 90s and early 2000s, generating enough randomized controls trials for a substantial systematic Cochrane review on the topic (a rare thing for TDM research!). It’s an ever-evolving space, where drug regimens are continually refined with newer drug options with fewer adverse effects. However, we have learned a lot through concentration monitoring, and TDM continues to be very useful in optimizing treatment. As our title suggests, this is a continuing story.

Our guests today are Natella Rakhmanina and Dario Cattaneo, who have been involved in the story since the beginning but from different perspectives, Natella as a paediatric infectious diseases specialist and Dario as a clinical pharmacologist. We cover the history, discuss the role that TDM has today and consider where things are headed.

In this episode we hear about: • The usefulness and limitations of using TDM to monitor adherence. • Diverse niche patient scenarios where TDM can be very helpful, which are not at all uncommon. • Interesting challenges where TDM can be helpful, some that are particular to paediatric patients, and others to elderly HIV patients. • Learnings from TDM for long-acting drugs in psychiatry, and the implications for novel depot antiretroviral formulations. • Drug interaction attributable to antiretrovirals, and those that affect them. • Why, despite viral monitoring, TDM for antiretrovirals can still be very useful. • What Paxlovid tastes like.

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:

Natella Rakhmanina is a Professor at the Department of Paediatrics, School of Medicine and Health Sciences of The George Washington University. She is also director of HIV Services of the Division of Infectious Diseases at the Children’s National Hospital in Washington.

Dario Cattaneo is currently the President of the IATDMCT. He is a clinical pharmacologist at Luigi Sacco University Hospital in Milan and an Adjunct Professor at the University of Milan, Italy.

Dario Cattaneo is currently the President of the IATDMCT. He is a clinical pharmacologist at Luigi Sacco University Hospital in Milan and an Adjunct Professor at the University of Milan, Italy.

Previous Episode

TDM of anticancer drugs: We can work it out!

This episode is about the TDM of anticancer therapies, a space where there is a sense of frustration about body-size based dosing, but while concentration-based promises to make a difference to clinical care, it still feels that progress has been less than satisfying. Florian opens the episode with an ode to oncologists, a song from the heart to say: ‘We can work it out!’

Our guests today are Dirk Jan Moes and Vikram Gota, both very active in ‘working things out’ in the space, in different corners of the world. We unpack the many challenges but arrive at the conclusion that for TDM in oncology, ‘the future is bright!’

In this episode we hear about:

Older anticancer drugs: can we do new tricks with old drugs, or have we missed the boat?
The importance of the drug label and reimbursement for clinical implementation
Anticancer drugs and clinical contexts where microsampling can enhance implementation
Financial toxicity: should we be styling ourselves as financial toxicologists!?
Progress in the paediatric space
Combining concentration measurement with pharmacogenetics, biomarkers and model informed precision dosing
Buy-in: the importance of clinical champions and education initiatives

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

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

About our guests:

Dirk Jan Moes is a Laboratory Hospital Pharmacist and Clinical Pharmacologist, Assistant Professor of Applied Clinical Pharmacometrics at the Department of Clinical Pharmacy and Toxicology at the Leiden University Medical Centre in The Netherlands.

Vikram Gota is an MD, Professor & Officer-in-charge of the Department of Clinical Pharmacology at the Advanced Centre for Treatment Research & Education in Cancer at the Tate Memorial Centre in Mumbai, India.

Next Episode

Personalized Under The Northern Sky! (IATDMCT Oslo 2023): Norwegian Wood

In this bonus episode, we delve into the upcoming IATDMCT congress that will take place September 24th to 27th in Oslo, Norway . It promises to be an exciting event with varied and highly novel sessions. Joining us today are esteemed IATDMCT scientists and local members of the congress organizing committee: Stein Bergan, Ida Robertson, and Anders Åsberg.

We delve into their motivations to host the congress and discuss the inspiration behind the theme: 'Personalized under the Northern Sky.' Our guests elaborate on how they will weave this overarching theme through the whole event. We explore some captivating sessions featured on the program, including therapeutic use of orellanine mushroom toxin, TDM of statins, acyclovir & ganciclovir, tacrolimus, microsampling approaches and hands-on sessions. Additionally, we cover the educational initiatives designed specifically for Young Scientists.

Prepare for an enriching experience filled not only with valuable scientific knowledge but also a great deal of fun. If that's not enough, get ready for some thrilling activities like running and the Holmenkollen Ski Jump. Register for the congress today!

In this episode we hear about:

● IATDMCT Oslo 2023: introducing our committee members ● The motivation behind the congress theme: Personalized Under the Northern Sky ● What’s in it for me? Why attend the Oslo congress. ● Double the usual number of plenaries, including one about the therapeutic use of orellanine mushroom toxin ● Hands-on pre-congress event: deep-dive into microsampling approaches to enhance clinical applications and research efforts ● Educational initiatives for Young Scientists ● Satisfying all your needs: networking opportunities, the social program and unique activities only Oslo can offer

About our guests:

Stein Bergan Congress Chair. Group leader at the precision pharmacotherapy research group of Oslo University Hospital, Dept of Pharmacology. He is also a professor of the department of Pharmacy at University of Oslo

Ida Robertson Associate Professor at the department of Pharmacy at University of Oslo and a member of the Pharmacokinetics Research Group.

Anders Åsberg Head of the laboratory for renal physiology at Oslo University Hospital and adjunct Professor of the department of Pharmacy at University of Oslo.