title: Validation of an automated method for compounding monoclonal antibody patient doses: case studies of Avastin (bevacizumab), Remicade (infliximab) and Herceptin (trastuzumab).
abstract: Automation robots have recently come to the market as an alternative for manual compounding of drugs for intravenous administration. Our aim was to assess whether robotic compounding can be performed with monoclonal antibodies (mAbs) without influencing the aggregation state of the proteins. Three frequently used mAbs were studied: infliximab (Remicade, Janssen Biotech) and trastuzumab (Herceptin, Roche) in lyophilised form, and bevacizumab (Avastin, Roche) as a liquid formulation stored at 2°C to 8°C. The effects of different procedures to prepare the patient doses on antibody aggregation were evaluated. Remicade and Herceptin were reconstituted both manually and by a robotic arm (i.v.STATION, Health Robotics). Additionally, the influence of vigorous shaking during reconstitution was investigated. The effects of rapid aspiration and dispensing on antibody aggregation were investigated for all three mAbs. Aggregation state was assessed by UV-Vis absorbance, 90° light scatter, fluorescence spectroscopy, Nile red fluorescence microscopy, and field flow fractionation without cross and focus flow. Robotic reconstituted samples showed similar findings compared with manual reconstitution if performed exactly according to the summary of product characteristics (SPC). Vials that were vigorously shaken showed a significant increase in aggregates. Similarly, rapid aspiration/dispense cycles resulted in a strong increase in the number and sizes of aggregates for all three mAbs; this result was observed after just one rapid aspiration/dispense cycle. Our study showed that robotic compounding of mAbs is feasible if the robot is exactly programmed according to the SPC, indicating that robotic compounding can be used to achieve reproducible high-quality compounding for delicate formulations.
authors.affiliation: Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, the Netherlands. b.peters@antoniusziekenhuis.nl
authors.forename: Bas J M
authors.initials: BJ
authors.lastname: Peters
authors.forename: Martinus A H
authors.initials: MA
authors.lastname: Capelle
authors.forename: Tudor
authors.initials: T
authors.lastname: Arvinte
authors.forename: Ewoudt M W
authors.initials: EM
authors.lastname: van de Garde
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000737:chemistry*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000737:chemistry; D001331:Automation; D000068258:Bevacizumab; D004339:Drug Compounding / Q000295:instrumentation / Q000379:methods*; D005427:Flocculation; D031521:Fractionation, Field Flow; D005612:Freeze Drying; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D012371:Robotics / Q000379:methods*; D000068878:Trastuzumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D000069285:Infliximab; D000068878:Trastuzumab