Rapid and sensitive liquid chromatographic-tandem mass spectrometric methods for the quantitation of dolutegravir in human plasma and breast milk.

Background: Dolutegravir (DTG) is part of a first-line antiretroviral therapy (ART) for HIV management in drug-naïve individuals and is recommended for the treatment of HIV during pregnancy. Robust analytical tools to quantify DTG are necessary to support clinical trials that characterize its multi-compartment drug distribution.

Methods: Potassium EDTA (KEDTA) plasma or whole breast milk was spiked with DTG and an isotopically labeled internal standard. Samples were prepared via protein precipitation prior to LC-MS/MS analysis. The assays were validated in accordance with regulatory recommendations.

Results: Analytical measuring ranges for DTG quantitation in plasma and breast milk were 100-10,000 ng/mL and 0.500 to 1000 ng/mL, respectively. Inter-assay precision and accuracy were 2.73 % to 3.41 % and -10.6 % to -5.37 % for plasma, and 4.24 % to 12.4 % and -5.63 % to 7.49 % for breast milk, respectively. DTG was stable for three freeze-thaw cycles and for at least 72 h at room temperature in matrix (plasma or breast milk). Additionally, whole blood was stable for 24 h at room temperature and 2 h under conditions of extended heat and humidity. Matrix effects for DTG in plasma and breast milk ranged from 101 % to 108 % and 78.2 % to 99.3 %, respectively. Quantitation in remnant plasma samples yielded measurable concentrations within the primary linearity of the assay.

Conclusions: Methods to quantify DTG in human plasma and breast milk have been developed and validated. These assays were designed to satisfy all criteria for implementation in clinical and clinical trial settings.