Saliva as a TDM Matrix and Its Application in the Model-Informed Precision Dosing

Area of Science:

• Pharmacology
• Analytical Chemistry
• Clinical Pharmacy

Background:

• Therapeutic drug monitoring (TDM) traditionally relies on plasma measurements.
• Saliva offers a non-invasive alternative matrix for TDM, with potential advantages in patient convenience and sample collection.
• Establishing population pharmacokinetic (Pop PK) models using saliva is an emerging area for personalized medicine.

Purpose of the Study:

• To systematically review the feasibility of using saliva as a matrix for TDM.
• To evaluate methods for saliva sample collection, testing, and Pop PK modeling.
• To summarize existing evidence and identify limitations for saliva TDM.

Main Methods:

• Systematic literature search of the PubMed database for studies on saliva TDM.
• Inclusion and exclusion criteria for literature screening.
• Data extraction and synthesis of findings on drug support for salivary TDM and Pop PK modeling.

Main Results:

• 112 articles and 73 drugs were reviewed; 53 drugs supported saliva TDM, 13 did not, and 7 had inconsistent results.
• Methods for saliva TDM and Pop PK modeling were summarized.
• Feasibility of saliva TDM for certain drugs was confirmed, with initial attempts at Pop PK modeling.

Conclusions:

• Saliva TDM is a feasible approach for a subset of drugs and holds promise for future clinical application.
• Pop PK modeling using saliva TDM for precision drug delivery is in its early stages and requires further clinical validation.
• This review provides a reference for future research in salivary TDM and Pop PK modeling.