Comparison of Two Commercially Available Fentanyl Screening Immunoassays for Clinical Use. (1st May 2020)

• Record Type: Journal Article
• Authors: Budelier, Melissa M; Franks, Caroline E; Logsdon, Nicole; Jannetto, Paul J; Scott, Mitchell G; Roper, Stephen M; Farnsworth, Christopher W
• Is Part Of: Journal of applied laboratory medicine. Volume 5:Number 6(2020)
• Page Start: 1277
• Page End: 1286
• Publication Date: 2020-05-01
• Subjects: Fentanyl -- drug screen -- method comparison; Clinical chemistry -- Periodicals; Diagnosis, Laboratory -- Periodicals; 616.0756
• DOI: 10.1093/jalm/jfaa048
• Languages: English
• ISSNs: 2576-9456

Abstract

Abstract: Background: Fentanyl is a synthetic opioid associated with illicit drug use and overdose deaths. The SEFRIA Immunalysis (IAL) and ARK fentanyl assays are both FDA-cleared, open channel immunoassays for fentanyl detection in urine. However, limited data are available in the literature comparing these assays. The objective of this study was to perform a direct comparison of these two fentanyl immunoassays. Methods: IAL and ARK fentanyl immunoassays were performed on a Roche Cobas e602 automated chemistry analyzer. Repeatability and total imprecision were compared by diluting fentanyl into urine at concentrations above, below, and at the manufacturers' cutoffs of 1.0 ng/mL. Cross-reactivity was assessed for norfentanyl and the fentanyl analogs acetylfentanyl, acrylfentanyl, and furanylfentanyl. Concordance was assessed in 90 patient samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS) as the gold standard. Results: Repeatability varied from 11.4%–17.8% on the IAL assay and 2.8%–5.5% on the ARK assay. Total imprecision was 18.9%–40.7% on the IAL assay and 2.9%–6.4% on the ARK assay. Both assays cross-reacted with acetylfentanyl (∼100%), acrylfentanyl (∼100%), and furanylfentanyl (∼20%), but only the ARK assay cross-reacted with norfentanyl (∼3%). An admixture of 0.5 ng/mL fentanyl and 6 ng/mL norfentanyl produced a positive result on the ARK assay. Total concordance between IAL and ARK for 90 tested patient samples was 93% (kappa = 0.85). Relative to LC-MS/MS, the IAL assay had a concordance of 90% (kappa = 0.79) and the ARK assay had a concordance of 94% (kappa = 0.88). Including norfentanyl in the LC-MS/MS confirmation increased the concordance of the ARK to 96% (kappa = 0.90). Conclusions: The ARK assay recognized the metabolite norfentanyl, demonstrated superior precision, and had better concordance with LC-MS/MS compared to the IAL assay.