New Monitoring Recommendations for Digoxin During the Last Decade Are Associated With Decreased Serum Digoxin Concentrations in Patient Samples

IF 3.3 4区 医学 Q2 PHARMACOLOGY & PHARMACY
Anders Larsson, Anna-Karin Hamberg, Jonathan Cedernaes, Pär Hallberg, Johanna Helmersson Karlqvist, Mathias Karlsson
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Abstract

Digoxin has long been used to manage atrial fibrillation and heart failure. While therapeutic drug monitoring (TDM) became available in the late 1960s, recent studies suggest increased mortality at serum levels > 1.0 ng/mL, prompting reassessment of the traditionally accepted range (0.8–2.0 ng/mL). This study evaluated trends in digoxin concentrations from 2004 to 2024 to assess alignment with updated recommendations. We retrospectively analysed 37 489 routine digoxin measurements from Uppsala University Hospital (2004–2024), including patient age, sex, sampling date and digoxin levels. Analytical platforms changed from Abbott's Architect to Roche's Cobas Pro during the study period. Trends over time and sex differences were evaluated. Of the samples, 17 771 were from males (median age 77) and 19 718 from females (median age 83). Median digoxin concentrations were 0.9 nmol/L for males and 1.0 nmol/L for females. About 30% of samples exceeded 1.2 nmol/L. Digoxin concentrations decreased over time (Spearman R = −0.191, p < 0.000001), particularly in higher values. Associations with age were modest. Serum digoxin levels have declined over the past two decades, reflecting evolving guidelines, though elevated levels remain common, highlighting the need for ongoing clinical-laboratory alignment.

Abstract Image

在过去十年中,新的地高辛监测建议与患者样本中地高辛血清浓度降低有关
地高辛长期用于治疗房颤和心力衰竭。虽然治疗性药物监测(TDM)在20世纪60年代末开始可用,但最近的研究表明,血清水平为1.0 ng/mL时死亡率增加,促使人们重新评估传统接受的范围(0.8-2.0 ng/mL)。本研究评估了2004年至2024年地高辛浓度的趋势,以评估与最新建议的一致性。我们回顾性分析了乌普萨拉大学医院(2004-2024)37489例地高辛常规检测结果,包括患者年龄、性别、采样日期和地高辛水平。在研究期间,分析平台从雅培的Architect改为罗氏的Cobas Pro。研究人员评估了不同时期的趋势和性别差异。其中男性17771例(中位年龄77岁),女性19718例(中位年龄83岁)。地高辛中位浓度男性为0.9 nmol/L,女性为1.0 nmol/L。约30%的样品超过1.2 nmol/L。地高辛浓度随着时间的推移而降低(Spearman R = - 0.191, p < 0.000001),特别是在较高的浓度时。与年龄的关系不大。血清地高辛水平在过去二十年中有所下降,反映了指南的不断发展,尽管水平升高仍然很常见,强调了持续进行临床-实验室校准的必要性。
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来源期刊
CiteScore
5.60
自引率
6.50%
发文量
126
审稿时长
1 months
期刊介绍: Basic & Clinical Pharmacology and Toxicology is an independent journal, publishing original scientific research in all fields of toxicology, basic and clinical pharmacology. This includes experimental animal pharmacology and toxicology and molecular (-genetic), biochemical and cellular pharmacology and toxicology. It also includes all aspects of clinical pharmacology: pharmacokinetics, pharmacodynamics, therapeutic drug monitoring, drug/drug interactions, pharmacogenetics/-genomics, pharmacoepidemiology, pharmacovigilance, pharmacoeconomics, randomized controlled clinical trials and rational pharmacotherapy. For all compounds used in the studies, the chemical constitution and composition should be known, also for natural compounds.
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