Thiopurine dosing using thiopurine methyltransferase status: a systematic review of clinical guidance

Burnett H, Tanoshima R, Chandranipapongse W, Madadi P, Ito S, Ungar WJ
Record ID 32014000442
Authors' objectives: The objective of this study was to conduct a systematic review of clinical guidance documents that recommend TPMT testing prior to the administration of thiopurine drugs. The specific aims were to 1) review the breadth of guidance documents and their sources, and 2) critically appraise the quality of the guidance documents by evaluating the quality of evidence used to support the preferential use of one method (genotyping versus phenotyping) over another and used to guide dose adjustments based on TPMT status.
Authors' recommendations: Clinical guidance on the use of pharmacogenetics is required to assist healthcare professionals with decisions regarding which test to order and how test results should be interpreted in order to improve patient care. Variations in recommendations for TPMT testing reflect the need for clarity in the clinical validity and utility of various TMPT test methods. The variability amongst these guidance documents also illustrates a lack of consistency and rigor in the methods used to develop recommendation statements. The development of high quality guidance for pharmacogenetic testing requires interdisciplinary collaboration between experts in the fields of genetics, pharmacology and the clinical disciplines responsible for administering the test-treatment combinations and careful adherence to methods for evidence-based guideline development. Systematic reviews of available evidence can be used to identify gaps in the literature which in turn can help inform judgments about the value of a test, as well as set research agendas.
Project Status: Completed
Year Published: 2013
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Canada
MeSH Terms
  • Humans
  • Methyltransferases
Organisation Name: Technology Assessment at SickKids
Contact Address: Program of Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 tel: (416) 813-8519 fax: (416) 813-5979
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Copyright: The Hospital for Sick Children Research Institute
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