Therapeutic drug monitoring (TDM) is typically referred to as the measurement of the concentration of drugs in patient blood. Although in the past, TDM was restricted to drugs with a narrow therapeutic range in order to avoid drug toxicity, TDM has recently become a major tool for precision medicine being applied to many more drugs. Through compensating for interindividual differences in a drug's pharmacokinetics, improved dosing of individual patients based on TDM ensures maximum drug effectiveness while minimizing side effects. This is especially relevant for individuals that present a particularly high intervariability in pharmacokinetics, such as newborns, or for critically/severely ill patients. In this article, we will review the applications for and limitations of TDM, discuss for which patients TDM is most beneficial and why, examine which techniques are being used for TDM, and demonstrate how mass spectrometry is increasingly becoming a reliable and convenient alternative for the TDM of different classes of drugs. We will also highlight the advances, challenges, and limitations of the existing repertoire of TDM methods and discuss future opportunities for TDM-based precision medicine.

中文翻译：

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基于液相色谱-质谱的治疗药物监测在精准医学中的实用性、前景和局限性

治疗药物监测 (TDM) 通常被称为对患者血液中药物浓度的测量。尽管过去为了避免药物毒性，TDM 仅限于治疗范围较窄的药物，但最近 TDM 已成为精准医学应用于更多药物的主要工具。通过补偿药物药代动力学的个体差异，基于 TDM 改善个体患者的剂量可确保最大的药物有效性，同时最大限度地减少副作用。这对于在药代动力学方面表现出特别高的相互变异性的个体（例如新生儿）或危重/重症患者尤其相关。在本文中，我们将回顾 TDM 的应用和局限性，讨论 TDM 对哪些患者最有益以及为什么，检查哪些技术正在用于 TDM，并展示质谱如何越来越成为不同类别药物 TDM 的可靠和方便的替代方法。我们还将强调现有 TDM 方法的进步、挑战和局限性，并讨论基于 TDM 的精准医学的未来机遇。