P.0911 Drug monitoring of aripiprazole, dehydroaripiprazole and the active moiety: A systematic review on the therapeutic reference range

2021 ◽  
Vol 53 ◽  
pp. S670
Author(s):  
X.M. Hart ◽  
G. Gruender ◽  
H.W. Clement ◽  
G. Schoretsanitis ◽  
A. Conca ◽  
...  
Keyword(s):  
Systematic Review ◽  
Drug Monitoring ◽  
Reference Range ◽  
Active Moiety

A Review on Prescription Drug Monitoring Program

2021 ◽  
pp. 265-268
Author(s):  
Someshwar D. Mankar ◽  
Abhijit S. Navale ◽  
Suraj R. Kadam
Keyword(s):  
Systematic Review ◽  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
Opioid Abuse ◽  
Prescription Opioid ◽  
Prescription Drug Monitoring Program ◽  
Prescription Opioid Abuse

Nowadays Prescription Opioid Abuse has become a serious problem, to monitor and reduce Opioid Abuse most of countries developed Prescription Drug Monitoring Program (PDMP). Regarding to this we conduct a systematic review to understanding the PDMP impact in order to reduce Opioid Abuse and improving prescriber practices. This review can help to guide efforts to better response to the Opioid crises.

scholarly journals Thiopurines’ Metabolites and Drug Toxicity: A Meta-Analysis

2020 ◽  
Vol 9 (7) ◽  
pp. 2216
Author(s):  
Paula Sousa ◽  
Maria Manuela Estevinho ◽  
Cláudia Camila Dias ◽  
Paula Ministro ◽  
Uri Kopylov ◽  
...  
Keyword(s):  
Systematic Review ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Alanine Aminotransferase ◽  
Odds Ratio ◽  
Drug Toxicity ◽  
Meta Analysis ◽  
Therapeutic Drug ◽  
Gastrointestinal Intolerance ◽  
The Relationship

Many questions remain unanswered regarding therapeutic drug monitoring (TDM) utility with thiopurines. This study aims to establish a relationship between thiopurines’ metabolites and drug toxicity. We performed a systematic review with inclusion of studies evaluating the relationship between thiopurines’ metabolites and drug toxicity. Meta-analysis of mean difference (MD), correlations and odds ratio (OR) was performed. We identified 21,240 records, 72 of which were eligible for meta-analysis. Levels of 6-thioguanine nucleotides (6-TGN) were higher in patients with leukopenia (MD 127.06 pmol/8 × 108 RBC) and gastrointestinal intolerance (MD 201.46 pmol/8 × 108 RBC), and lower in patients with hepatotoxicity (MD −40.6 pmol × 108 RBC). We established a significant correlation between 6-TGN and leukocytes (r = −0.21), neutrophils (r = −0.24) and alanine aminotransferase levels (r = −0.24). OR for leukopenia in patients with elevated 6-TGN was 4.63 (95% CI 2.24; 9.57). An optimal cut-off of 135 pmol/8 × 108 RBC for leukopenia was calculated (sensitivity 75.4%; specificity 46.4%). 6-methylmercaptopurine ribonucleotides (6-MMPR) were significantly associated with hepatotoxicity (MD 3241.2 pmol/8 × 108 RBC; OR 4.28; 95% CI 3.20; 5.71). Levels of 6-MMPR measured in the first 8 weeks of treatment were associated with leukopenia. We conclude that TDM could be used to prevent thiopurines’ toxicity. As optimal metabolites level may vary according to indication, physicians may adapt posology to decrease toxicity without compromising efficacy.

Is Therapeutic Drug Monitoring for Anti-tumour Necrosis Factor Agents in Adults With Inflammatory Bowel Disease Ready for Standard of Care? A Systematic Review and Meta-analysis

2020 ◽  
Vol 14 (8) ◽  
pp. 1057-1065 ◽  
Author(s):  
Raj Shah ◽  
Gila R Hoffman ◽  
Mohammed El-Dallal ◽  
Alexander M Goldowsky ◽  
Ye Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Inflammatory Bowel Disease ◽  
Therapeutic Drug Monitoring ◽  
Bowel Disease ◽  
Drug Monitoring ◽  
Meta Analysis ◽  
Therapeutic Drug ◽  
Quality Of Evidence ◽  
Inflammatory Bowel

Abstract Introduction Using therapeutic drug monitoring [TDM] in adult patients with inflammatory bowel disease [IBD] remains controversial. We conducted a systematic review and meta-analysis to answer four clinical PICO [Population, Intervention, Comparator, Outcome] questions. Methods We searched MEDLINE, Embase, Web of Science, and Cochrane Central from inception to June 30, 2019. Remission was defined by the manuscripts’ definitions of clinical remission. Data were analysed using RevMan 5.3. Quality of evidence was assessed with GRADE methodology. Results We identified and screened 3365 abstracts and 11 articles. PICO 1 Reactive vs No TDM: six studies pooled showed 57.1% [257/450] failed to achieve remission following reactive TDM vs 44.7% [268/600] in the no TDM group (risk ratio [RR]: 1.14; 95% confidence interval [CI] 0.88–1.47). PICO 2 Proactive vs no TDM: five studies pooled showed 19.5% [75/384] failed to maintain remission in the proactive TDM group vs 33.4% [248/742] in the no TDM group [RR: 0.60; 95% CI 0.35–1.04]. PICO 3 Proactive vs Reactive TDM: two retrospective studies pooled showed 14.2% [26/183] failure to maintain remission in the proactive TDM group and 64.7% [119/184] in the reactive TDM group [RR: 0.22; 95% CI 0.15–0.32]. PICO 4 TDM [proactive/reactive] vs No TDM: we pooled 10 studies showing 39.7% [332/837] failed to achieve remission in the TDM [proactive/reactive] cohort vs 40.3% [428/1063] in the no TDM cohort [RR: 0.94; 95% CI 0.77–1.14]. Overall, the quality of evidence in each PICO was very low when using GRADE. Conclusions This meta-analysis shows that data supporting use of TDM in adults are limited and of very low quality. Further well-designed randomized controlled trials are needed to determine the place of TDM in clinical practice.

Abstract P200: Computerized Clinical Decision Support Systems for Therapeutic Drug Monitoring and Dosing: A Decision Maker--Researcher Partnership Systematic Review

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Robby Nieuwlaat ◽  
Stuart J Connolly ◽  
Jean A MacKay ◽  
Lorraine Weise-Kelly ◽  
Tamara Navarro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Therapeutic Drug Monitoring ◽  
Decision Maker ◽  
Patient Outcomes ◽  
Vitamin K ◽  
Drug Monitoring ◽  
Vitamin K Antagonist ◽  
Therapeutic Drug ◽  
Process Of Care ◽  
Cluster Randomization

Background Optimization of the return on investments in information technology innovations requires that current best evidence be considered for an effect on care processes and health outcomes. Computerized clinical decisions support systems (CCDSSs) might improve therapeutic drug monitoring and dosing (TDMD) by providing patient-tailored clinical recommendations. We summarized current evidence from randomized controlled trials (RCTs) for the effect of CCDSSs on TDMD. Methods A decision-maker - researcher partnership systematic review was performed to optimize the practical implementation of results. Studies from a previous review on the effect of CCDSSs (Garg AX, 2005) were included if they addressed TDMD and were RCTs. Additional RCTs were sought until January 2010 in MEDLINE, EMBASE, Evidence-Based Medicine Reviews and Inspec databases. RCTs assessing the effect of a CCDSS on process of care or patient outcomes were selected by pairs of independent reviewers. Results In total, 33 RCTs were identified that assessed the effect of a CCDSS on management of vitamin K antagonists (14), insulin (6), theophylline/aminophylline (4), aminoglycosides (3), digoxin (2), lidocaine (1), or as part of a multifaceted approach (3). All studies combined enrolled 24,627 patients; 13,219 were in the largest study, and only 6 other studies enrolled over 500 patients. Most studies were performed in one center (63%) and cluster randomization, of either clinics or physicians, was rarely used (18%). CCDSSs were usually stand-alone systems (76%) primarily used by physicians (85%). Overall, 18 of 30 studies (60%) showed an improvement in the process of care and 4 of 19 (21%) an improvement in patient outcomes. All evaluable studies assessing insulin dosing for glycemic control showed an improvement. In meta-analysis, CCDSSs for vitamin K antagonist dosing improved the time that patients spent in the therapeutic range by 6.1% (95% confidence interval: 0.46-11.83; p=0.03). Conclusions CCDSSs have potential for improving process of care for TDMD, specifically insulin and vitamin K antagonist dosing, but effects on patient outcomes were uncertain. More potent CCDSSs are needed and should be evaluated using cluster randomization, primarily assessing patient outcomes.

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