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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