TDM of antiretroviral drugs: The continuing story (of Bungalow Bill)…
Release Date: 06/01/2023
Tuberculosis drugs TDM: The long and winding road
Eight Drugs a Week Podcast
Tuberculosis remains one of the world's most persistent infectious diseases, and despite decades of available treatments, achieving cure remains a long and winding road. The challenge isn't just the disease itself – there is also a notable difference in how patients respond to TB drugs. Where pharmacokinetic variability can range 20-50 fold and the complex multidrug regimens, therapeutic drug monitoring represents a crucial but underutilised tool. From the early bactericidal activity in the first two weeks to managing drug-resistant strains, TDM offers a path to optimising treatment while...
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Revolution 9: How the microbiome is evolving our understanding of drug disposition
Eight Drugs a Week Podcast
The human microbiome, a complex community of bacteria, fungi, protozoa, and viruses, doesn't just passively coexist with the drugs we take; it actively participates in a bidirectional relationship that can impact drug efficacy and toxicity. From immunosuppressants in transplant patients to medicines in other fields of medicine, it is becoming apparent that the microbiome has been a missing piece in our understanding of drug variability, and that it can uniquely impact drug interactions. As this field rapidly evolves, it promises new strategies for personalising medicine through microbiome...
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IATDMCT annual meeting in Singapore. I’ve got a meeting (I’ve got a feeling)
Eight Drugs a Week Podcast
We gather the two chairs of the upcoming IATDMCT annual meeting in Singapore, Sophie Stocker and Jana Stojanova, plus Cindy Lau, who contribute to the organization of the young scientists’ part of the event to discuss the content, urbi et orbi, of our annual meeting. In this episode we’ll hear about: The journey from an inspiration to the building of a real conference dedicated to creating innovative solutions in therapeutic drug monitoring and clinical toxicology. The keynote lectures, main topics and hosts selected highlights of a scientific program going from biosensors applications...
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IATDMCT annual meeting in Singapore. I’ve got a meeting (I’ve got a feeling)
Eight Drugs a Week Podcast
We gather the two chairs of the upcoming IATDMCT annual meeting in Singapore, Sophie Stocker and Jana Stojanova, plus Cindy Lau, who contribute to the organization of the young scientists’ part of the event to discuss the content, urbi et orbi, of our annual meeting. In this episode we’ll hear about: The journey from an inspiration to the building of a real conference dedicated to creating innovative solutions in therapeutic drug monitoring and clinical toxicology. The keynote lectures, main topics and hosts selected highlights of a scientific program going from biosensors applications...
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Pharmacogenetics: Here, There and Everywhere
Eight Drugs a Week Podcast
Pharmacogenetics now surrounds us and is an efficient tool to prevent disease or to guide drug therapy. By studying polymorphisms in the genes coding for metabolism enzymes and drug transporters, we can have clues to help choose the right drug or adjust drug dosage. Not to mention that pharmacogenetics is the ideal companion for therapeutic drug monitoring for a comprehensive treatment optimization. Treatment failure and adverse drug reactions may, at least partly, be explained with pharmacogenetics and we have never been so close to large-scale implementation of this strategy. In this...
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TDM for beta-lactams in critical care: You know my name (Look up the number)
Eight Drugs a Week Podcast
Given we traditionally only monitored particular antibiotics to spare toxicity, and that beta lactams were widely considered such safe drugs, it was once difficult to imagine this drug class would become important TDM candidates. A bit more than a decade ago we started to see the first reports about augmented renal clearance in critically ill patients, often in situations in which antibiotic treatment was crucial, such as sepsis. TDM of beta lactams in the critical care is now recognised as a valuable tool to ensure adequate drug exposure and optimise therapeutic outcomes for these vulnerable...
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Exploring new frontiers in TDM and toxicology (IATDMCT Banff 2024): Not a second time!
Eight Drugs a Week Podcast
This time, it’s the right time - not a second time, but a unique time - to take the road to Banff, Canada, for the 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...
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Machine learning and AI for individualised therapy: Now and then
Eight Drugs a Week Podcast
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...
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IATDMCT Young Scientists: When I’m 64!
Eight Drugs a Week Podcast
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...
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Got to get microsampling into my life: Got to get you into my life!
Eight Drugs a Week Podcast
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...
info_outlineThis 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
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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.