TDM is dead. Long live TCI!

Nick Holford1, Guangda Ma1, David Metz2

  • 1Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand.

Insights

Target Concentration Intervention (TCI) offers superior precision over traditional Therapeutic Drug Monitoring (TDM). Evidence suggests TCI should replace TDM in modern healthcare for better patient outcomes.

Area of Science:

  • Pharmacology and Clinical Pharmacy
  • Drug Dosing Strategies
  • Evidence-Based Medicine

Background:

  • Therapeutic Drug Monitoring (TDM) has been a cornerstone of drug therapy.
  • Target Concentration Intervention (TCI) emerged two decades ago, proposing enhanced precision.
  • TCI links pharmacokinetic and pharmacodynamic principles for individualized dosing.

Purpose of the Study:

  • To evaluate the theoretical benefits of TCI compared to TDM.
  • To review clinical trial evidence supporting TCI's superiority.
  • To advocate for the adoption of TCI in contemporary clinical practice.

Main Methods:

  • Systematic review of theoretical frameworks for TCI and TDM.
  • Analysis of clinical trial data comparing TCI and TDM efficacy.
  • Examination of pharmacokinetic and pharmacodynamic principles in drug dosing.

Main Results:

  • TCI demonstrates greater precision in achieving target drug concentrations.
  • Clinical evidence supports improved patient outcomes with TCI over TDM.
  • The integration of pharmacokinetics and pharmacodynamics is more effectively utilized in TCI.

Conclusions:

  • TCI offers significant clinical advantages over traditional TDM.
  • The digital age facilitates the implementation and benefits of TCI.
  • TDM should be superseded by TCI for optimized drug therapy management.

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