RENERIO FRAGUAS JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Psiquiatria, Faculdade de Medicina - Docente
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Factors associated with higher quality of clinical practice guidelines and their recommendations for the pharmacological treatment of depression: a systematic review(2023) GABRIEL, Franciele Cordeiro; MELO, Daniela Oliveira de; STEIN, Airton Tetelbom; FONTES-MOTA, Gessica Caroline Henrique; SANTOS, Itamires Benicio dos; RODRIGUES, Camila da Silva; RODRIGUES, Monica Cristiane; RIBEIRO, Tatiane Bomfim; FRAGUAS, Renerio; FLOREZ, Ivan D.; TELLES-CORREIA, Diogo; RIBEIRO, ElianeObjective The objective of this study was to assess the quality of clinical practice guidelines (CPGs) for the pharmacological treatment of depression along with their recommendations and factors associated with higher quality. Design We conducted a systematic review that included CPGs for the pharmacological treatment of depression in adults. Data sources We searched for publications from 1 January 2011 to 31 December 2021, in MEDLINE, Cochrane Library, Embase, PsycINFO, BVS and 12 other databases and guideline repositories. Eligibility criteria for selecting studies We included CPGs containing recommendations for the pharmacological treatment of depression in adults at outpatient care setting, regardless of whether it met the U.S. National Academy of Medicine criteria, or not. If a CPG included recommendations for both children and adults, they were considered. No language restriction was applied. Data extraction and synthesis Data extraction was also conducted independently and in duplicate, a process that was validated in a previous project. The quality of the CPGs and their recommendations were assessed by three independent reviewers using Appraisal of Guidelines for Research and Evaluation (AGREE II) and Appraisal of Guidelines for Research and Evaluation-Recommendations Excellence (AGREE-REX). A CPG was considered to be of high quality if AGREE II Domain 3 was >= 60%; while their recommendations were considered high if AGREE-REX Domain 1 was >= 60%. Results Seventeen out of 63 (27%) CPGs were classified as high quality, while 7 (11.1%) had high-quality recommendations. The factors associated with higher-scoring CPGs and recommendations in the multiple linear regression analyses were 'Handling of conflicts of interest', 'Multiprofessional team' and 'Type of institution'. 'Inclusion of patient representative in the team' was also associated with higher-quality recommendations. Conclusions The involvement of professionals from diverse backgrounds, the handling of conflicts of interest, and the inclusion of patients' perspectives should be prioritised by developers aiming for high-quality CPGs for the treatment of depression.
- Quality of clinical practice guidelines for inadequat response to first-line treatment for depression according to AGREE II checklist and comparison of recommendations: a systematic review(2022) GABRIEL, Franciele Cordeiro; STEIN, Airton Tetelbom; MELO, Daniela Oliveira de; FONTES-MOTA, Gessica Caroline Henrique; SANTOS, Itamires Benicio dos; OLIVEIRA, Aliandra Fantinell de; FRAGUAS, Renerio; RIBEIRO, ElianeObjective To assess similarities and differences in the recommended sequence of strategies among the most relevant clinical practice guidelines (CPGs) for the treatment of depression in adults with inadequate response to first-line treatment. Data sources We performed a systematic review of the literature spanning January 2011 to August 2020 in Medline, Embase, Cochrane Library and 12 databases recognised as CPGs repositories. CPGs quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Study selection The eligibility criteria were CPGs that described pharmacological recommendations for treating depression for individuals aged 18 years or older in outpatient care setting. We included CPGs considered of high-quality (>= 80% in domain 3 of AGREE II) or recognised as clinically relevant. Data extraction Two independent researchers extracted recommendations for patients who did not respond to first-line pharmacological treatment from the selected CPGs. Results We included 46 CPGs and selected 8, of which 5 were considered high quality (>= 80% in domain 3 of AGREE II) and 3 were recognised as clinically relevant. Three CPGs did not define inadequate response to treatment and 3 did not establish a clear sequence of strategies. The duration of treatment needed to determine that a patient had not responded was not explicit in 3 CPGs and was discordant in 5 CPGs. Most CPGs agree in reassessing the diagnosis, assessing the presence of comorbidities, adherence to treatment, and increase dosage as first steps. All CPGs recommend psychotherapy, switching antidepressants, and considering augmentation/combining antidepressants. Conclusion Relevant CPGs present shortcomings in recommendations for non-responders to first-line antidepressant treatment including absence and divergencies in definition of inadequate response and sequence of recommended strategies. Overall, most relevant CPGs recommend reassessing the diagnosis, evaluate comorbidities, adherence to treatment, increase dosage of antidepressants, and psychotherapy as first steps. PROSPERO registration number CRD42016043364.