An updated examination of the perception of barriers for pharmacogenomics implementation and the usefulness of drug/gene pairs in Latin America and the Caribbean
Authors: Salas-Hernández Aimeé , Galleguillos Macarena , Carrasco Matías , López-Cortés Andrés , Redal María Ana , Fonseca-Mendoza Dora , Esperón Patricia , González-Martínez Farith , Lares-Asseff Ismael , Lazarowski Alberto , Loera-Castañeda Verónica , Remírez Diadelis , Martínez Matías F. , Vargas Rodrigo , Rios-Santos Fabricio , Macho Antonio , Cayún Juan P. , Perez Germán R. , Gutierrez Carolina , Cerpa Leslie C. , Leiva Tamara , Calfunao Susan , Xajil Lesly , Sandoval Christopher , Suárez Marcelo , Gonzalez Ariana , Echeverría-Garcés Gabriela , Sullón-Dextre Luis , Cordero-García Eugenia , Morales Alexis R. , Avendaño Andrea , Sánchez Enrique , Bastone Laura C. , Lara Cesar , Zuluaga-Arias Patricia , Soler Ana María , Da Luz Julio , Burgueño-Rodríguez Gabriela , Vital Marcelo , Reyes-Reyes Elizabeth , Huaccha Alexander , Ariza Yeimy V. , Tzul Naomi , Rendón Ana L. , Serrano Roberto , Acosta Larissa , Motta-Pardo Angelo , Beltrán-Angarita Leonardo , Brand Erika , Jiménez Miguel A. , Hidalgo-Lozada Gladys Maribel , Romero-Prado Marina M. J. , Escobar-Castro Karla , Umaña-Rivas Mariel , Vivas Juan D. , Lagos Paola , Martínez Yineth Ballén , Quesada Sharleth , Calfio Camila , Arias Maria L. , Lavanderos María A. , Cáceres Dante D. , Salazar-Granara Alberto , Varela Nelson M. , Quiñones Luis A. 
Published: May 2023

Pharmacogenomics (PGx) is considered an emergent field in developing countries. Research on PGx in the Latin American and the Caribbean (LAC) region remains scarce, with limited information in some populations. Thus, extrapolations are complicated, especially in mixed populations. In this paper, we reviewed and analyzed pharmacogenomic knowledge among the LAC scientific and clinical community and examined barriers to clinical application. We performed a search for publications and clinical trials in the field worldwide and evaluated the contribution of LAC. Next, we conducted a regional structured survey that evaluated a list of 14 potential barriers to the clinical implementation of biomarkers based on their importance. In addition, a paired list of 54 genes/drugs was analyzed to determine an association between biomarkers and response to genomic medicine. This survey was compared to a previous survey performed in 2014 to assess progress in the region. The search results indicated that Latin American and Caribbean countries have contributed 3.44% of the total publications and 2.45% of the PGx-related clinical trials worldwide thus far. A total of 106 professionals from 17 countries answered the survey. Six major groups of barriers were identified. Despite the region’s continuous efforts in the last decade, the primary barrier to PGx implementation in LAC remains the same, the “need for guidelines, processes, and protocols for the clinical application of pharmacogenetics/pharmacogenomics”. Cost-effectiveness issues are considered critical factors in the region. Items related to the reluctance of clinicians are currently less relevant. Based on the survey results, the highest ranked (96%–99%) gene/drug pairs perceived as important were CYP2D6/tamoxifen, CYP3A5/tacrolimus, CYP2D6/opioids, DPYD/fluoropyrimidines, TMPT/thiopurines, CYP2D6/tricyclic antidepressants, CYP2C19/tricyclic antidepressants, NUDT15/thiopurines, CYP2B6/efavirenz, and CYP2C19/clopidogrel. In conclusion, although the global contribution of LAC countries remains low in the PGx field, a relevant improvement has been observed in the region. The perception of the usefulness of PGx tests in biomedical community has drastically changed, raising awareness among physicians, which suggests a promising future in the clinical applications of PGx in LAC.