Dried Blood Spot (DBS) as a useful tool to improve clozapine, aripiprazole and paliperidone treatment: From adherence to efficiency

September 23, 2022

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Publicated to:Revista De Psiquiatria Y Salud Mental. 15 (4): 230-237 - 2022-12-01 15(4), DOI: 10.1016/j.rpsm.2022.04.002

Authors: Bernardo, Miguel; Mezquida, Gisela; Ferre, Paula; Cabrera, Bibiana; Torra, Merce; Lizana, Ana Maria; Brunet, Merce

Affiliations

August Pi i Sunyer Biomed Res Inst IDIBAPS, Hosp Clin Barcelona, SBGM, Pharmacol & Toxicol Lab - Author

Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute - Author

Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Department of Medicine, University of Barcelona, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research - Author

Pharmacology and Toxicology Laboratory, SBGM, Hospital Clínic of Barcelona, Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBEREHD), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, - Author

Pharmacology and Toxicology Laboratoy, SBGM, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain - Author

Univ Barcelona, August Pi i Sunyer Biomed Res Inst IDIBAPS, Biomed Res Networking Ctr Hepat & Digest Dis CIB, Pharmacol & Toxicol Lab,SBGM,Hosp Clin Barcelona - Author

Univ Barcelona, August Pi i Sunyer Biomed Res Inst IDIBAPS, Biomed Res Networking Ctr Mental Hlth Network CI, Pharmacol Unit,Dept Basic Clinal Practice - Author

Univ Barcelona, Barcelona Clin Schizophrenia Unit, Hosp Clin Barcelona,Biomed Res Networking Ctr Men, Neurosci Inst,Dept Med,August Pi i Sunyer Biomed - Author

Abstract

Introduction: Therapeutic Drug Monitoring (TDM) of antipsychotics in schizophrenia is a powerful tool that allows tailoring the treatment in an individualized approach. Our goals are to develop and validate a Dried Blood Spot (DBS) method for monitoring some commonly used antipsychotics (aripiprazole, clozapine, and paliperidone) and to evaluate its usefulness as a compliance biomarker, as well as in drug-dose adjustment to personalize the antipsychotic treatment to improve its efficacy and safety. Methods: 31 first-psychotic episode (FEP) and schizophrenia patients were included; 5 refer to naïve FEP who started antipsychotic treatment; 26, to patients with more than one episode and under antipsychotic treatment: aripiprazole (7 cases), clozapine (17), paliperidone (11). For DBS sample collection, 25 ?l of capillary blood were placed in the spot of a FTA™DMPK-C-card. After completely dryness, antipsychotics were extracted and analyzed by a validated UHPLC-MS/MS-method. DBS antipsychotic results were compared with those obtained in venous blood/plasma. Results: Aripiprazole, paliperidone and clozapine showed from good to excellent correlations between concentrations in venous blood and DBS capillary blood (r2, from 0.500 to 0.721). The correlation between conventional plasma and DBS concentrations for paliperidone, aripiprazole, clozapine, and their metabolites were moderate, suggesting that optimal drug target concentrations should be established for DBS. Conclusions: In this study, for aripiprazole, dehydroaripiprazole, paliperidone, clozapine and desmethylclozapine, DBS has provided good analytical performance for TDM. Thus, DBS sampling can offer a great alternative over conventional sampling for plasma measurement. The assay provides good analytical performances for TDM and clinical research applicability, suggesting that DBS is a promising clinical application in TDM in psychiatry. © 2022 SEP y SEPB

Keywords

AdherenceAdherenciaAnálisis de sangre seca (dried blood spot [dbs])AntipsicóticoAntipsychoticAntipsychotic agentsAripiprazoleClozapineDried blood spot (dbs)EsquizofreniaHumansMonitorización terapéutica de medicamentosPaliperidone palmitateSchizophreniaTandem mass spectrometryTherapeutic drug monitoring (tdm)

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Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Revista De Psiquiatria Y Salud Mental due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 15/155, thus managing to position itself as a Q1 (Primer Cuartil), in the category Psychiatry. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.14. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

Field Citation Ratio (FCR) from Dimensions: 3.9 (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-16, the following number of citations:

WoS: 9
Scopus: 9
Europe PMC: 6

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Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Bernardo Arroyo, Miguel) and Last Author (Brunet Serra, Mercedes).

the author responsible for correspondence tasks has been Brunet Serra, Mercedes.

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