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Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice

BACKGROUND: Many medicines are dosed to achieve a particular therapeutic range, and monitored using therapeutic drug monitoring (TDM). The evidence base for a therapeutic range can be evaluated using systematic reviews, to ensure it continues to reflect current indications, doses, routes and formula...

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Autores principales: Cooney, Lewis, Loke, Yoon K., Golder, Su, Kirkham, Jamie, Jorgensen, Andrea, Sinha, Ian, Hawcutt, Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455119/
https://www.ncbi.nlm.nih.gov/pubmed/28577540
http://dx.doi.org/10.1186/s12874-017-0363-z
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author Cooney, Lewis
Loke, Yoon K.
Golder, Su
Kirkham, Jamie
Jorgensen, Andrea
Sinha, Ian
Hawcutt, Daniel
author_facet Cooney, Lewis
Loke, Yoon K.
Golder, Su
Kirkham, Jamie
Jorgensen, Andrea
Sinha, Ian
Hawcutt, Daniel
author_sort Cooney, Lewis
collection PubMed
description BACKGROUND: Many medicines are dosed to achieve a particular therapeutic range, and monitored using therapeutic drug monitoring (TDM). The evidence base for a therapeutic range can be evaluated using systematic reviews, to ensure it continues to reflect current indications, doses, routes and formulations, as well as updated adverse effect data. There is no consensus on the optimal methodology for systematic reviews of therapeutic ranges. METHODS: An overview of systematic reviews of therapeutic ranges was undertaken. The following databases were used: Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts and Reviews of Effects (DARE) and MEDLINE. The published methodologies used when systematically reviewing the therapeutic range of a drug were analyzed. Step by step recommendations to optimize such systematic reviews are proposed. RESULTS: Ten systematic reviews that investigated the correlation between serum concentrations and clinical outcomes encompassing a variety of medicines and indications were assessed. There were significant variations in the methodologies used (including the search terms used, data extraction methods, assessment of bias, and statistical analyses undertaken). Therapeutic ranges should be population and indication specific and based on clinically relevant outcomes. Recommendations for future systematic reviews based on these findings have been developed. CONCLUSION: Evidence based therapeutic ranges have the potential to improve TDM practice. Current systematic reviews investigating therapeutic ranges have highly variable methodologies and there is no consensus of best practice when undertaking systematic reviews in this field. These recommendations meet a need not addressed by standard protocols.
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spelling pubmed-54551192017-06-06 Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice Cooney, Lewis Loke, Yoon K. Golder, Su Kirkham, Jamie Jorgensen, Andrea Sinha, Ian Hawcutt, Daniel BMC Med Res Methodol Research Article BACKGROUND: Many medicines are dosed to achieve a particular therapeutic range, and monitored using therapeutic drug monitoring (TDM). The evidence base for a therapeutic range can be evaluated using systematic reviews, to ensure it continues to reflect current indications, doses, routes and formulations, as well as updated adverse effect data. There is no consensus on the optimal methodology for systematic reviews of therapeutic ranges. METHODS: An overview of systematic reviews of therapeutic ranges was undertaken. The following databases were used: Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts and Reviews of Effects (DARE) and MEDLINE. The published methodologies used when systematically reviewing the therapeutic range of a drug were analyzed. Step by step recommendations to optimize such systematic reviews are proposed. RESULTS: Ten systematic reviews that investigated the correlation between serum concentrations and clinical outcomes encompassing a variety of medicines and indications were assessed. There were significant variations in the methodologies used (including the search terms used, data extraction methods, assessment of bias, and statistical analyses undertaken). Therapeutic ranges should be population and indication specific and based on clinically relevant outcomes. Recommendations for future systematic reviews based on these findings have been developed. CONCLUSION: Evidence based therapeutic ranges have the potential to improve TDM practice. Current systematic reviews investigating therapeutic ranges have highly variable methodologies and there is no consensus of best practice when undertaking systematic reviews in this field. These recommendations meet a need not addressed by standard protocols. BioMed Central 2017-06-02 /pmc/articles/PMC5455119/ /pubmed/28577540 http://dx.doi.org/10.1186/s12874-017-0363-z Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Cooney, Lewis
Loke, Yoon K.
Golder, Su
Kirkham, Jamie
Jorgensen, Andrea
Sinha, Ian
Hawcutt, Daniel
Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice
title Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice
title_full Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice
title_fullStr Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice
title_full_unstemmed Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice
title_short Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice
title_sort overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455119/
https://www.ncbi.nlm.nih.gov/pubmed/28577540
http://dx.doi.org/10.1186/s12874-017-0363-z
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