Liquid chromatography-tandem mass spectrometry or automated immunoassays: what are the future trends in therapeutic drug monitoring?

Therapeutic drug monitoring (TDM) of certain drugs with a narrow therapeutic index significantly improves patient outcome. For example, the quantification of immunosuppressive drugs in samples from patients after organ transplantation is an essential prerequisite for the prevention of both adverse drug reactions and rejection events. The need for accurate, precise, and standardized measurement of drugs presents a major challenge for clinical laboratories and the diagnostics industry. A plethora of different techniques have been developed in the past to meet these requirements. Currently, liquid chromatography–tandem mass spectrometry (LC-MS/MS)-based methods and immunoassays appear to be the most prevalent approaches in clinical laboratories. Since these techniques differ in many aspects, in making the choice the laboratory must consider the technical, clinical, and economic criteria, as well as staff qualifications.