Voulgaridou Gavriela, Paraskeva Theodora, Ragia Georgia, Atzemian Natalia, Portokallidou Konstantina, Kolios George, Arvanitidis Konstantinos, Manolopoulos Vangelis G
Laboratory of Pharmacology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
IMPReS-Individualised Medicine & Pharmacological Research Solutions Center, 68100 Alexandroupolis, Greece.
Pharmaceutics. 2023 Aug 23;15(9):2181. doi: 10.3390/pharmaceutics15092181.
Therapeutic drug monitoring (TDM) is the clinical practice of measuring drug concentrations. TDM can be used to determine treatment efficacy and to prevent the occurrence or reduce the risk of drug-induced side effects, being, thus, a tool of personalized medicine. Drugs for which TDM is applied should have a narrow therapeutic range and exhibit both significant pharmacokinetic variability and a predefined target concentration range. The aim of our study was to assess the current status of TDM in Greek public hospitals and estimate its progress over the last 20 years. All Greek public hospitals were contacted to provide data and details on the clinical uptake of TDM in Greece for the years 2003 and 2021 through a structured questionnaire. Data from 113 out of 132 Greek hospitals were collected in 2003, whereas for 2021, we have collected data from 98 out of 122 hospitals. Among these, in 2003 and 2021, 64 and 51 hospitals, respectively, performed TDM. Antiepileptics and antibiotics were the most common drug categories monitored in both years. The total number of drug measurement assays decreased from 2003 to 2021 (153,313 ± 7794 vs. 90,065 ± 5698; = 0.043). In direct comparisons between hospitals where TDM was performed both in 2003 and 2021 (n = 35), the mean number of measurements was found to decrease for most drugs, including carbamazepine (198.8 ± 46.6 vs. 46.6 ± 10.1, < 0.001), phenytoin (253.6 ± 59 vs. 120 ± 34.3; = 0.001), amikacin (147.3 ± 65.2 vs. 91.1 ± 71.4; = 0.033), digoxin (783.2 ± 226.70 vs. 165.9 ± 28.9; < 0.001), and theophylline (71.5 ± 28.7 vs. 11.9 ± 6.4; = 0.004). Only for vancomycin, a significant increase in measurements was recorded (206.1 ± 96.1 vs. 789.1 ± 282.8; = 0.012). In conclusion, our findings show that TDM clinical implementation is losing ground in Greek hospitals. Efforts and initiatives to reverse this trend are urgently needed.
治疗药物监测（TDM）是测量药物浓度的临床实践。TDM可用于确定治疗效果，并预防药物不良反应的发生或降低其风险，因此是个性化医疗的一种工具。适用TDM的药物应具有较窄的治疗范围，表现出显著的药代动力学变异性以及预定义的目标浓度范围。我们研究的目的是评估希腊公立医院中TDM的现状，并估计其在过去20年中的进展。通过一份结构化问卷，联系了所有希腊公立医院，以提供2003年和2021年希腊TDM临床应用的数据和详细信息。2003年从132家希腊医院中的113家收集了数据，而对于2021年，我们从122家医院中的98家收集了数据。其中，2003年和2021年分别有64家和51家医院进行了TDM。抗癫痫药和抗生素是这两年中最常监测的药物类别。从2003年到2021年，药物测量检测的总数有所下降（153313±7794对90065±5698；P = 0.043）。在2003年和2021年都进行了TDM的医院（n = 35）之间的直接比较中，发现大多数药物的测量平均数下降，包括卡马西平（198.8±46.6对46.6±10.1，P < 0.001）、苯妥英（253.6±59对120±34.3；P = 0.001）、阿米卡星（147.3±65.2对91.1±71.4；P = 0.033）、地高辛（783.2±226.70对165.9±28.9；P < 0.001）和茶碱（71.5±28.7对11.9±6.4；P = 0.004）。仅万古霉素的测量数有显著增加（206.1±96.1对789.1±282.8；P = 0.012）。总之，我们的研究结果表明，TDM的临床应用在希腊医院中正在失去阵地。迫切需要做出努力和采取举措来扭转这一趋势。
