title: LC-MS/MS Method for Determination of Teriflunomide, Over a 40,000-Fold Dynamic Range Using Overlapping Calibrators.
abstract: BACKGROUND
  A liquid chromatography tandem mass spectrometry (LC-MS/MS) method has been validated for use in therapeutic monitoring of the drug leflunomide in human serum and plasma. Because of concerns of teratogenicity, it is recommended that women who want to become pregnant have concentrations below 0.02 mcg/mL, although therapeutic levels are generally greater than 20 mcg/mL. Consequently, the method required a 40,000-fold dynamic range, which was achieved by dividing the curve range into 2 separate regions but with a single extraction procedure used for both.
  
  
  METHODS
  A chromatographic separation was achieved between the parent drug and the active metabolite, teriflunomide (A77 1726), and the latter was quantified across a quantitative range of 0.005-200 mcg/mL. Samples were evaluated in an upper curve region first, with dilution, to determine whether the drug concentrations were in an appropriate therapeutic range. Samples that fell below the upper region were then reevaluated in the lower region without dilution.
  
  
  RESULTS
  The method was shown to be reliable, with good accuracy and precision statistics, and acceptable quantitation using 4 different collection tube types. Mean accuracy over 6 control concentrations was within 5.4%, over 5 validation runs, whereas %coefficient of variation (CV) was within 8.15%. Evaluation of sodium heparin, KEDTA, NaF/K oxalate, and plain serum tubes from 6 separate individuals at the lower limit of quantification (LLOQ) showed no influence on the ability to quantify teriflunomide accurately. Regression equations for a curve range of 0.005-1 mcg/mL gave R values of 0.998 or better, whereas the range 0.8-200 mcg/mL had R values of 0.997 or better.
  
  
  CONCLUSIONS
  The authors have developed and validated a method that allows quantification of leflunomide across a 40,000-fold range of 0.005-200 mcg/mL.
authors.affiliation: *ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories; and †Department of Pathology, University of Utah Health Sciences Center, Salt Lake City.
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Rule
authors.forename: Alan L
authors.initials: AL
authors.lastname: Rockwood
authors.forename: Kamisha L
authors.initials: KL
authors.lastname: Johnson-Davis
mesh_terms: D002138:Calibration; D002853:Chromatography, Liquid / Q000592:standards; D003437:Crotonates / Q000097:blood*; D006801:Humans; D006885:Hydroxybutyrates; D057230:Limit of Detection; D009570:Nitriles; D012015:Reference Standards; D015203:Reproducibility of Results; D053719:Tandem Mass Spectrometry / Q000592:standards; D014052:Toluidines / Q000097:blood*
chemical_list: D003437:Crotonates; D006885:Hydroxybutyrates; D009570:Nitriles; D014052:Toluidines; C527525:teriflunomide