Analysis of depression in Brazil and the feasibility of incorporating pharmacogenomics as an auxiliary tool in antidepressant treatment
DOI:
https://doi.org/10.1590/Keywords:
Depression, Pharmacogenomics, Pharmacogenomic testingAbstract
Depression has substantially increased in the last 10 years in Brazil, and mental health became a concerning issue for the public health globally, especially considering the COVID-19 pandemic. The therapeutic conduct in depression mainly relies on medication and psychotherapy. However, more than one attempt in the treatment can be considered a common procedure before finding out the right medication. This conduct leads many patients to give up following pharmacological treatment. In this scenario, pharmacogenomics emerges as a possible supporting tool of the medical treatment. This paper aims to analyze the scenario of depression in Brazil and the viability of pharmacogenomic tests implementation as a part of the medical procedure. Official data bank from the Brazilian government was used to analyze the prevalence of depressive disorder, as well as Pharmacogenomic data bases and relevant articles around this topic. Additionally, pharmacogenomic tests typically take into consideration the genes CYP2D6 and CYP2C19, which are relevant for antidepressant treatment. Data shows that these tests could help patients achieve remission of symptoms, and they could also be economically advantageous. Thus, pharmacogenomic tests present as an interesting approach for the therapeutic conduct of depression and can significantly improve the health quality of this affected population.
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Agência Nacional de Saúde Suplementar (ANS). Lista completa de procedimentos - Rol de Procedimentos e Eventos em Saúde, 2023 [Internet]. 2023 [cited 2023 Apr 13]. Available from: Available from: https://www.gov.br/ans/pt-br/assuntos/consumidor/o-que-o-seu-plano-de-saude-deve-cobrir-1/o-que-e-o-rol-de-procedimentos-e-evento-em-saude
Almeida BC, Gonçalves ED, de Sousa MH, Osis MJMD, de Brito Mota MJB, Planello AC. Perception and knowledge of pharmacogenetics among Brazilian psychiatrists. Psychiatry Res. 2021 Dec 1;306.
Bousman CA, Arandjelovic K, Mancuso SG, Eyre HA, Dunlop BW. Pharmacogenetic tests and depressive symptom remission: A meta-analysis of randomized controlled trials. Pharmacogenomics. 2019 Jan;20(1):37-47.
Bousman CA, Bengesser SA, Aitchison KJ, Amare AT, Aschauer H, Baune BT, et al. Review and Consensus on Pharmacogenomic Testing in Psychiatry. Vol. 54, Pharmacopsychiatry. Georg Thieme Verlag; 2021. p. 5-17.
Bousman CA, Stevenson JM, Ramsey LB, Sangkuhl K, Hicks JK, Strawn JR, et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A Genotypes and Serotonin Reuptake Inhibitor Antidepressants. Clin Pharmacol Ther. 2023;114(1):51-68. Accepted Author Manuscript [Internet]. Available from: https://ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.2903
» https://ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.2903
Brasil. LEI No 14.454, de 21 de setembro de 2022. Altera a Lei no 9.656, de 3 de junho de 1998, que dispõe sobre os planos privados de assistência à saúde, para estabelecer critérios que permitam a cobertura de exames ou tratamentos de saúde que não estão incluídos no rol de procedimentos e eventos em saúde suplementar. [Internet]. Brasília: Congresso Brasileiro; Sep 21, 2022. Available from: https://www.in.gov.br/en/web/dou/-/lei-n-14.454-de-21-de-setembro-de-2022-431275000
» https://www.in.gov.br/en/web/dou/-/lei-n-14.454-de-21-de-setembro-de-2022-431275000
Brown LC, Stanton JD, Bharthi K, Maruf AAl, Müller DJ, Bousman CA. Pharmacogenomic Testing and Depressive Symptom Remission: A systematic review and meta-analysis of prospective, controlled clinical trials. Clin Pharmacol Ther . 2022 Dec 1;112(6):1303-17.
Conselho Federal de Farmácia (CFF). Vendas de medicamentos para depressão aumentaram 13% este ano. 2021 [Internet]. 2021 [cited 2023 Jan 24]. Available from: Available from: https://www.cff.org.br/impressao.php?noticia=6428
» https://www.cff.org.br/impressao.php?noticia=6428
FDA. Table of Pharmacogenetic Associations, 2022 [Internet]. 2022 [cited 2023 Mar 7]. Available from: Available from: https://www.fda.gov/medical-devices/precision-medicine/table-pharmacogenetic-associations
» https://www.fda.gov/medical-devices/precision-medicine/table-pharmacogenetic-associations
Ferrari A, Santomauro D, Mantilla Herrera A, Shadid J, Ashbaugh C, Erskine H, et al. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022 Feb 1;9(2):137-50.
Fiocruz. Pesquisa Nacional de Saúde (PNS) - ICICT [Internet]. 2021 [cited 2023 Jan 24]. Available from: Available from: https://www.pns.icict.fiocruz.br/
» https://www.pns.icict.fiocruz.br/
Fontes S. Venda de remédio genérico para depressão salta 56% na pandemia. Valor Economico Globo [Internet]. 2022 Jun 6 [cited 2023 Jan 24]; Available from: Available from: https://valor.globo.com/empresas/noticia/2022/06/06/venda-de-remedio-generico-para-depressao-salta-56-na-pandemia.ghtml
Greden JF, Parikh S V., Rothschild AJ, Thase ME, Dunlop BW, DeBattista C, et al. Impact of pharmacogenomics on clinical outcomes in major depressive disorder in the GUIDED trial: A large, patient-and rater-blinded, randomized, controlled study. J Psychiatr Res. 2019 Apr 1;111:59-67.
IBGE. Pesquisa Nacional de Saúde - PNS [Internet]. 2022 [cited 2023 Jan 24]. Available from: Available from: https://sidra.ibge.gov.br/pesquisa/pns
» https://sidra.ibge.gov.br/pesquisa/pns
Karamperis K, Koromina M, Papantoniou P, Skokou M, Kanellakis F, Mitropoulos K, et al. Economic evaluation in psychiatric pharmacogenomics: a systematic review. Pharmacogenomics J. 2021 Aug 1;21(4):533-41.
Kim V, Wal T Van Der, Nishi MY, Montenegro LR, Carrilho FJ, Hoshida Y, et al. Brazilian cohort and genes encoding for drug-metabolizing enzymes and drug transporters. Pharmacogenomics. 2020 Jun 1;21(9):575-86.
Koopmans AB, Braakman MH, Vinkers DJ, Hoek HW, van Harten PN. Meta-analysis of probability estimates of worldwide variation of CYP2D6 and CYP2C19. Transl Psychiatry. 2021 Jun 1;11(1).
Milosavljević F, Bukvić N, Pavlović Z, Miljević Č, Pešić V, Molden E, et al. Association of CYP2C19 and CYP2D6 Poor and Intermediate Metabolizer Status with Antidepressant and Antipsychotic Exposure: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2021 Mar 1;78(3):270-80.
Murphy LE, Fonseka TM, Bousman CA, Müller DJ. Gene-drug pairings for antidepressants and antipsychotics: level of evidence and clinical application. Mol Psychiatry. 2021;27(1):593-605.
PharmGKB. Pharmacogenomics Knowledge Base [Internet]. 2023 [cited 2023 Jan 19]. Available from: Available from: https://www.pharmgkb.org
Pirmohamed M. Pharmacogenomics: current status and future perspectives. Nat Rev Genet. 2023;24(6):350-362.
Rosenblat JD, Lee Y, McIntyre RS. The effect of pharmacogenomic testing on response and remission rates in the acute treatment of major depressive disorder: A meta-analysis. J Affect Disord. 2018 Dec 1;241:484-91.
Santomauro DF, Mantilla Herrera AM, Shadid J, Zheng P, Ashbaugh C, Pigott DM, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021 Nov 6;398(10312):1700-12.
Swen JJ, van der Wouden CH, Manson LE, Abdullah-Koolmees H, Blagec K, Blagus T, et al. A 12-gene pharmacogenetic panel to prevent adverse drug reactions: an open-label, multicentre, controlled, cluster-randomised crossover implementation study. Lancet. 2023;401:347.
Torres-Loureiro S, Scudeler MM, Andrade PXC, Sampaio-Coelho J, Nobre IH, Céspedes-Garro C, et al. Pharmacogenetics research in Brazil: a systematic review. Pharmacogenomics. 2022 Mar 1;23(4):263-75.
Tuteja S, Salloum RG, Elchynski AL, Smith DM, Rowe E, Blake K V, et al. Multisite evaluation of institutional processes and implementation determinants for pharmacogenetic testing to guide antidepressant therapy. Clin Transl Sci. 2022 Feb 1;15(2):371-83.
Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel). Vigitel Brasil 2021 - Vigilância de fatores de risco e proteção para doenças Crônicas por inquérito telefônico - Estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção Para doenças crônicas nas capitais dos 26 estados Brasileiros e no Distrito Federal em 2021 [Internet]. Correia de Medeiros A, Araújo de França GV, Pereira Vasconcelos de Oliveira P, editors. Brasília, DF: MINISTÉRIO DA SAÚDE- Secretaria de Vigilância em Saúde Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis; 2022 p. 96-99 [cited 2023 Feb 1]. Available from: Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/publicacoes-svs/vigitel/vigitel-brasil-2021-estimativas-sobre-frequencia-e-distribuicao-sociodemografica-de-fatores-de-risco-e-protecao-para-doencas-cronicas/view
Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico. Vigitel 2023 - Estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2023 [Internet]. 2023 p. 103-106 [cited 2023 Dec 22]. Available from: Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/svsa/vigitel/vigitel-brasil-2023-vigilancia-de-fatores-de-risco-e-protecao-para-doencas-cronicas-por-inquerito-telefonico
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