CPIC Seeks Feedback on Recommendation Strength and Gene/Drug Pair Level Definitions

CPIC is proposing changes to CPIC Guideline grades for strength of recommendation and for definitions of CPIC Levels of gene/drug pairs.

Based on a review of other practices and challenges presented by some CPIC gene/drug pairs, it is recommended that the option "no recommendation" be added to the three current recommendation strengths for diplotype/drugs: strong, moderate, optional. To reflect this additional prescribing recommendation category, the definition of a CPIC level C has been revised to include cases where there are few published studies or mostly weak evidence and the clinical actions are unclear.

Additionally, CPIC would like to assign a level (A, B, C or D) to drugs that are listed in CPIC guidelines as “not good alternatives” but are not explicitly the subject of a CPIC guideline recommendation (e.g. the codeine guideline recommends not using tramadol as an alternative). Also, some guidelines include recommendations that may be reasonably applied to similar agents (e.g. imipramine treated like other TCAs). By slightly revising the definition of an “optional” recommendation to include cases where the “evidence is weak or based on extrapolations,” some of these alternative drugs can be assigned a CPIC level B or C, depending on levels of evidence.

The proposed changes are found at the CPIC website and are open for comment.  Please send comments to cpic@pharmgkb.org by September 12, 2016.