Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice
Abstract 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...
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doaj-d39d177d2c6c4ab99ec39d267148ae4c2020-11-24T21:43:26ZengBMCBMC Medical Research Methodology1471-22882017-06-011711910.1186/s12874-017-0363-zOverview of systematic reviews of therapeutic ranges: methodologies and recommendations for practiceLewis Cooney0Yoon K. Loke1Su Golder2Jamie Kirkham3Andrea Jorgensen4Ian Sinha5Daniel Hawcutt6Institute of Translational Medicine, University of LiverpoolSchool of Medicine, Health Policy and Practice, University of East AngliaDepartment of Health Sciences, University of YorkDepartment of Biostatistics, University of LiverpoolDepartment of Biostatistics, University of LiverpoolRespiratory Department, Alder Hey Children’s HospitalInstitute of Translational Medicine, University of LiverpoolAbstract 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.http://link.springer.com/article/10.1186/s12874-017-0363-zSystematic review methodologyTherapeutic rangeSystematic review |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lewis Cooney Yoon K. Loke Su Golder Jamie Kirkham Andrea Jorgensen Ian Sinha Daniel Hawcutt |
spellingShingle |
Lewis Cooney Yoon K. Loke Su Golder Jamie Kirkham Andrea Jorgensen Ian Sinha Daniel Hawcutt Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice BMC Medical Research Methodology Systematic review methodology Therapeutic range Systematic review |
author_facet |
Lewis Cooney Yoon K. Loke Su Golder Jamie Kirkham Andrea Jorgensen Ian Sinha Daniel Hawcutt |
author_sort |
Lewis Cooney |
title |
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_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_sort |
overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice |
publisher |
BMC |
series |
BMC Medical Research Methodology |
issn |
1471-2288 |
publishDate |
2017-06-01 |
description |
Abstract 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. |
topic |
Systematic review methodology Therapeutic range Systematic review |
url |
http://link.springer.com/article/10.1186/s12874-017-0363-z |
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