Clinical benefits of pharmacogenetic algorithm-based XXXX dosing: meta-analysis of randomized controlled trials.

@entity1 @entity2643 @entity548 @entity1031 @entity1229
BACKGROUND: Pharmacogenetic (PG) algorithms were proposed to predict @entity1229 therapeutic dose more accurately. However, the clinical efficacy of the strategy over the standard treatment was not consistently proven. METHODS: We conducted a meta-analysis of the published randomized controlled trials (RCTs) comparing PG algorithm-based @entity1229 dosing (PG group) with clinical or standard protocols (STD group). The PUBMED, EMBASE, Cochrane Library and Web of Science databases were searched up to June 2014. RESULTS: A total of 10 RCTs were retrieved for the meta-analysis with the inclusion of 2,601 @entity1 . Primary analysis showed both major @entity548 (2.65% versus 4.75%; RR: 0.57, 95% CI: 0.37- 0.90, P=0.02) and @entity1031 events (0.59% versus 1.88%; RR: 0.38, 95% CI: 0.17-0.85, P=0.02) were significantly lower in PG than in STD group. There was a trend towards increased percentage of time in therapeutic range (%TTR) [mean difference (MD): 4.65, 95% CI: 0.01- 9.29, P=0.05] in PG group, but no difference was observed for over-anticoagulation (INR>4). Subgroup analyses showed significant @entity548 and @entity1031 events in PG group when the follow-up time was more than 1month. After stratified by different PG algorithms, significant major @entity548 reduction could be found in PG group when @entity1229 indication or co-medication of @entity2643 was integrated in the algorithms. CONCLUSION: PG algorithm-guided @entity1229 anticoagulation is beneficial for the @entity548 and @entity1031 events compared with standard dosing strategy. The benefits may be prominent in @entity1 with longer follow-up time, or guided by refined PG algorithms.
