Table 4 Clinical implications of systematic reviews of therapeutic ranges
From: Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice
Clinical improvement (lower limit) | Suspected adverse effects (upper limit) | Clinical implication |
|---|---|---|
Better in ‘therapeutic’ participants compared to subtherapeutic | Higher frequency or severity in supratherapeutic participants compared with therapeutic | No change to clinical practice, therapeutic range is correct |
Better in ‘therapeutic’ participants compared to subtherapeutic | No difference between therapeutic and supratherapeutic participants | Clinicians should aim serum levels above the lower limit. Additional studies to determine accurate upper range may be required |
No difference between therapeutic and subtherapeutic participants | Higher in supratherapeutic participants compared with therapeutic | Clinicians should aim for serum levels below the upper limit. Additional studies to determine the lower range may be required |
No difference between therapeutic and subtherapeutic participants | No difference between therapeutic and supratherapeutic participants | Existing therapeutic range not related to outcomes of interest. Additional studies to determine optimal therapeutic range and/or if TDM beneficial for this drug/indication/population |