ADERSON OMAR MOURAO CINTRA DAMIAO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
60 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 60
- Fatal Presentation of Thrombotic Cutaneous Gangrene Associated With Acute Severe Colitis(2023) BARROS, Luisa Leite; PRADO, Rita de Cassia Parente; FERREIRA, Lucas Fortes Portela; AZEVEDO, Matheus Freitas Cardoso de; OBA, Jane; CARLOS, Alexandre de Souza; DAMIAO, Aderson Omar Mourao Cintra
- Anti-TNF Therapy in Elderly Patients With Inflammatory Bowel Disease in a Tuberculosis-Endemic Country(2023) BARROS, Luisa Leite; AZEVEDO, Matheus Freitas Cardoso de; CARLOS, Alexandre de Souza; LOPES, Paula De Azevedo; FUJITA, Andre Okuhara; BRITO, Daniela Sanches; KAMADA, Daniela Midori; PRADO, Rita de Cassia Parente; ANDRADE, Julia Carvalho De; OBA, Jane; DAMIAO, Aderson Omar Mourao Cintra
- Prevalence of dysplasia and colorectal cancer in Ulcerative Colitis patients from a referral center in Latin America(2021) JUNIOR, R. S. F.; CARVALHO, M. F.; SILVA, J. C.; BARROS, L. L.; AZEVEDO, M. F. C.; CARLOS, A. D. S.; OBA, J.; HASHIMOTO, C. L.; CANCADO, E. L. R.; DAMIAO, A. O. M. C.; SIPAHI, A. M.
- Efficacy of Early Optimization of Infliximab Guided by Therapeutic Drug Monitoring during Induction-A Prospective Trial(2023) GARCIA, Karoline Soares; AZEVEDO, Matheus Freitas Cardoso de; CARLOS, Alexandre de Sousa; BARROS, Luisa Leite; OBA, Jane; SOBRADO JUNIOR, Carlos Walter; SIPAHI, Aytan Miranda; ALVES, Olivia Duarte de Castro; NAVARRO-RODRIGUEZ, Tomas; PARRA, Rogerio Serafim; CHEBLI, Julio Maria Fonseca; CHEBLI, Liliana Andrade; FLORES, Cristina; VIEIRA, Andrea; CEARA, Christianne Damasceno Arcelino do; QUEIROZ, Natalia Sousa Freitas; DAMIAO, Aderson Omar Mourao CintraTherapeutic drug monitoring (TDM) during induction therapy with anti-tumor necrosis factor drugs has emerged as a strategy to optimize response to these biologics and avoid undesired outcomes related to inadequate drug exposure. This study aimed to describe clinical, biological, and endoscopic remission rates at six months in Brazilian inflammatory bowel disease (IBD) patients following a proactive TDM algorithm guided by IFX trough levels (ITL) and antibodies to IFX (ATI) levels during induction, at week six. A total of 111 IBD patients were prospectively enrolled, excluding those previously exposed to the drug. ITL & GE; 10 & mu;g/mL was considered optimal. Patients with suboptimal ITL (<10 & mu;g/mL) were guided according to ATI levels. Those who presented ATI & LE; 200 ng/mL underwent dose intensification in the maintenance phase, and patients with ATI > 200 ng/mL discontinued IFX. In our study, proactive TDM was associated with persistence in the IFX rate at six months of 82.9%. At that time, rates of clinical, biological, and endoscopic remission in patients under IFX treatment were 80.2%, 73.9%, and 48.1%, respectively. Applying a simplified TDM-guided algorithm during induction seems feasible and can help improve patients' outcomes in clinical practice.
- Long-term effectiveness and safety of ustekinumab in bio-naive and bio-experienced anti-tumor necrosis factor patients with Crohn's disease: a real-world multicenter Brazilian study(2022) PARRA, Rogerio Serafim; CHEBLI, Julio Maria Fonseca; QUEIROZ, Natalia Sousa Freitas; DAMIAO, Aderson Omar Mourao Cintra; AZEVEDO, Matheus Freitas Cardoso de; CHEBLI, Liliana Andrade; BERTGES, Erika Ruback; ALVES JUNIOR, Antonio Jose Tiburcio; AMBROGINI JUNIOR, Orlando; SILVA, Bianca Loyo Pona Schiavetti da; LUBINI, Marcio; BAFUTTO, Mauro; FLORES, Cristina; VILELA, Eduardo Garcia; BORATTO, Sandra Felice; GASPARETTI JUNIOR, Newton Luiz Tricarico; STEINWURZ, Flavio; CARVALHO, Nayara Salgado; FERES, Omar; ROCHA, Jose Joaquim Ribeiro daBackground The effectiveness of ustekinumab (UST) in the treatment of Crohn's disease (CD) has been demonstrated in the pivotal Phase 3 UNITI 1 and 2 and IM-UNITI studies in both anti-TNF-naive and anti-TNF-exposed patients. Given the selective nature of pivotal trial designs, real-world effectiveness and safety studies are warranted. We report our experience with UST treatment in a large, real-world multicenter cohort of Brazilian patients with CD. Methods We performed a retrospective multicenter study including patients with CD, predominantly biologically refractory CD, who received UST. The primary endpoint was the proportion of patients in clinical remission at weeks 8, 24 and 56. Possible predictors of clinical and biological response/remission and safety outcomes were also assessed. Results Overall, 245 CD (mean age 39.9 [15-87]) patients were enrolled. Most patients (86.5%) had been previously exposed to biologics. According to nonresponder imputation analysis, the proportions of patients in clinical remission at weeks 8, 24 and 56 were 41.0% (n = 98/239), 64.0% (n = 153/239) and 39.3% (n = 94/239), respectively. A biological response was achieved in 55.4% of patients at week 8, and 59.3% were in steroid-free remission at the end of follow-up. No significant differences in either clinical or biological remission were noted between bio-naive and bio-experienced patients. Forty-eight patients (19.6%) presented 60 adverse events during the follow-up, of which 8 (13.3%) were considered serious adverse events (3.2% of 245 patients). Overall, a proximal disease location, younger age, perianal involvement, and smoking were associated with lower rates of clinical remission over time. Conclusions UST therapy was effective and safe in the long term in this large real-life cohort of Brazilian patients with refractory CD, regardless of previous exposure to other biological agents.
- Safety of anti-TNF introduction following tuberculosis treatment in Inflammatory Bowel Disease patients in an endemic area(2021) AZEVEDO, M. F. C. D.; JUSTUS, F. F.; LIMA, C. C. G.; GARCIA, K. S.; BARROS, L. L.; OBA, J.; CARLOS, A. D. S.; MILANI, L. R.; SIPAHI, A. M.; DAMIAO, A. O. M. C.; QUEIROZ, N. S. F.
- Active tuberculosis in inflammatory bowel disease patients: a case-control study(2023) AZEVEDO, Matheus Freitas Cardoso de; BARROS, Luisa Leite; JUSTUS, Filipe Fernandes; OBA, Jane; GARCIA, Karoline Soares; MARTINS, Camilla de Almeida; CARLOS, Alexandre de Sousa; LEITE, Andre Zonetti Arruda; SIPAHI, Aytan Miranda; QUEIROZ, Natalia Sousa Freitas; DAMIAO, Aderson Omar Mourao CintraBackground/Aims:Anti-tumor necrosis factor (anti-TNF) drugs have been the mainstay therapy for moderate to severe inflammatory bowel disease (IBD) over the past 25 years. Nevertheless, these drugs are associated with serious opportunistic infections like tuberculosis (TB). Brazil is ranked among the 30 countries with the highest incidence of TB in the world. This study aimed at identifying risk factors for the development of active TB and describing clinical characteristics and outcomes in IBD patients followed at a tertiary referral center in Brazil. Methods:We conducted a retrospective, case-control study between January 2010 and December 2021. Active TB cases in IBD patients were randomly matched 1:3 to controls (IBD patients with no previous history of active TB) according to gender, age, and type of IBD. Design:This was a retrospective, case-control study. Results:A total of 38 (2.2%) cases of TB were identified from 1760 patients under regular follow-up at our outpatient clinics. Of the 152 patients included in the analysis (cases and controls), 96 (63.2%) were male, and 124 (81.6%) had Crohn's disease. Median age at TB diagnosis was 39.5 [interquartile range (IQR) 30.8-56.3]. Half of the active TB cases were disseminated (50%). Overall, 36 patients with TB (94.7%) were being treated with immunosuppressive medications. Of those, 31 (86.1%) were under anti-TNF drugs. Diagnosis of TB occurred at a median of 32 months after the first dose of anti-TNF (IQR 7-84). In multivariate analysis, IBD diagnosis older than 17 years and anti-TNF therapy were significantly associated with the development of TB (p < 0.05). After the TB treatment, 20 (52.7%) patients received anti-TNF therapy, and only one developed 'de novo' TB 10 years after the first infection. Conclusions:TB remains a significant health problem in IBD patients from endemic regions, especially those treated with anti-TNFs. In addition, age at IBD diagnosis (>17 years old) was also a risk factor for active TB. Most cases occur after long-term therapy, suggesting a new infection. The reintroduction of anti-TNFs agents after the anti-TB treatment seems safe. These data highlight the importance of TB screening and monitoring in IBD patients living in endemic areas.
- Conventional therapy for moderate to severe inflammatory bowel disease: A systematic literature review(2019) DAMIAO, Aderson Omar Mourao Cintra; AZEVEDO, Matheus Freitas Cardoso de; CARLOS, Alexandre de Sousa; WADA, Marcela Yumi; SILVA, Taciana Valeria Marcolino; FEITOSA, Flavio de CastroBACKGROUND Despite the advent of biological drugs, conventional therapy continues to be used in moderate to severe inflammatory bowel disease (MS-IBD). This study hypothesized that as a standard of treatment and the primary alternative to biologics, conventional therapy should present robust effectiveness results in IBD outcomes. AIM To investigate the effectiveness of conventional therapy for MS-IBD. METHODS A systematic review with no time limit was conducted in July 2017 through the Cochrane Collaboration, MEDLINE, and LILACS databases. The inclusion criteria encompassed meta-analyses, systematic reviews, randomized clinical trials, observational and case-control studies concerning conventional therapy in adult patients with MS-IBD, including Crohn's disease (CD) and ulcerative colitis (UC). Corticosteroids (prednisone, hydrocortisone, budesonide, prednisolone, dexamethasone), 5-aminosalicylic acid (5-ASA) derivatives (mesalazine and sulfasalazine) and immunosuppressants [azathioprine (AZA), methotrexate (MTX), mycophenolate, cyclosporine, tacrolimus, 6-mercaptopurine (6-MP)] were considered conventional therapy. The exclusion criteria were sample size below 50; narrative reviews; specific subpopulations (e.g., pregnant women, comorbidities); studies on postoperative IBD; and languages other than English, Spanish, French or Portuguese. The primary outcome measures were clinical remission (induction or maintenance), clinical response and mucosal healing. As secondary outcomes, fecal calprotectin, hospitalization, death, and surgeries were analyzed. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS The search strategy identified 1995 citations, of which 27 were considered eligible (7 meta-analyses, 20 individual studies). For induction of clinical remission, four meta-analyses were selected (AZA and 6-MP showed no advantage over placebo, MTX or 5-ASA in CD; MTX showed no statistically significant difference versus placebo, 6-MP, or 5-ASA in UC; tacrolimus was superior to placebo for UC in two meta-analyses). Only one meta-analysis evaluated clinical remission maintenance, showing no statistically significant difference between MTX and placebo, 5-ASA, or 6-MP in UC. AZA and 6-MP had no advantage over placebo in induction of clinical response in CD. Three meta-analyses showed the superiority of tacrolimus vs placebo for induction of clinical response in UC. The clinical response rates for cyclosporine were 41.7% in randomized controlled trials (RCTs) and 55.4% in non-RCTs for UC. For induction of mucosal healing, one meta-analysis showed a favorable rate with tacrolimus versus placebo for UC. For secondary outcomes, no meta-analyses specifically evaluated fecal calprotectin, hospitalization or death. Two meta-analyses were retrieved evaluating colectomy rates for tacrolimus and cyclosporine in UC. Most of the twenty individual studies retrieved contained a low or very low quality of evidence. CONCLUSION High-quality evidence assessing conventional therapy in MS-IBD treatment is scarce, especially for remission maintenance, mucosal healing and fecal calprotectin.
- ADALIMUMAB FOR ULCERATIVE COLITIS: RESULTS OF A BRAZILIAN MULTICENTER OBSERVATIONAL STUDY(2017) ZACHARIAS, Patrícia; DAMIÃO, Aderson Omar Mourão Cintra; MORAES, Antonio Carlos; TEIXEIRA, Fábio Vieira; LUDVIG, Juliano Coelho; NONES, Rodrigo Bremer; SAAD-HOSSNE, Rogerio; SASSAKI, Ligia Yukie; SILVA, Rosemary Pereira Lino da; FACCHIN, Luiza; OLANDOSKI, Marcia; KOTZE, Paulo GustavoABSTRACT BACKGROUND: Adalimumab is a monoclonal antibody, tumor necrosis factor-alpha (TNFα) inhibitor that has efficacy for inducing and maintaining remission in moderate-to-severe ulcerative colitis. Real world studies with adalimumab in Latin American ulcerative colitis patients are scarce. OBJECTIVE: To assess the clinical remission rates in induction and maintenance with adalimumab therapy in ulcerative colitis. METHODS: Observational, multicenter and retrospective study on a case series of patients with moderate-to-severe ulcerative colitis under adalimumab therapy. The variables analyzed were: demographic data, previous infliximab status, concomitant drugs, the Montreal Classification, disease activity (Mayo score) at weeks 0, 8, 26 and 52, or until the last follow-up. Clinical remission was defined as a partial Mayo score ≤2 and Last observation carried forward (LOCF) and Non responder imputation (NRI) analysis were used. RESULTS: Thirty-six patients were included in the study. With LOCF analysis, remission rates at weeks 8, 26 e 52 were of 41.7%, 47.2% and 47.2%, respectively. With NRI analysis, remission rates at weeks 8, 26 and 52 were of 41.7%, 41.7% and 27.8%, respectively. CONCLUSION: Adalimumab was effective in the treatment of moderate-to-severe ulcerative colitis. Clinical remission was observed in approximately 40% of the patients at weeks 8 and 26, and in almost a quarter of the patients after 1 year of follow up.
bookPart Necessidades Nutricionais em Pessoas Saudáveis(2016) PUCCI, Nidia Denise; MENEZES, Fernanda Lourenço de; DAMIãO, Adérson Omar Mourão Cintra