HELIO ELKIS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Psiquiatria, Faculdade de Medicina - Docente
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
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- Clozapine prescription trends in Brazil in the last decade(2022) MASSUDA, Raffael; GAMA, Clarissa S.; BELMONTE-DE-ABREU, Paulo; ELKIS, Helio; LUCENA, David Freitas de; BRESSAN, Rodrigo; NOTO, Cristiano; GADELHA, AryObjective: Clozapine is a second-generation antipsychotic indicated for treatment-resistant schizophrenia. Studies in several countries have shown a low rate of clozapine use despite the fact that approximately 30% of schizophrenia cases are treatment-resistant. In Brazil, few studies have addressed the frequency and variety of antipsychotic use in individuals diagnosed with schizophrenia (ICD F20). The objective of this study was to measure the rates of clozapine use in this population in the last decade using Brazilian Ministry of Health data. Methods: Prescriptions made between 2010 and 2020 in all 26 states and the Federal District registered at the Outpatient Information System Database from the Brazilian Health System (SIASUS) were evaluated. Results: A total of 25,143,524 prescriptions were recorded in this period, with clozapine representing 8.86% of all antipsychotics. The most frequently prescribed antipsychotic for patients with schizophrenia was olanzapine (35.8%), followed by quetiapine (27.5%). From 2010 to 2020, the rate of clozapine prescriptions in Brazil increased from 7.2% to 10.9%. Conclusions: Despite a slight increase in prescriptions in the last decade, clozapine is still underutilized in Brazil.
- Identifying strategies to improve PANSS based dimensional models in schizophrenia: Accounting for multilevel structure, Bayesian model and clinical staging(2022) HIGUCHI, Cinthia H.; COGO-MOREIRA, Hugo; FONSECA, Lais; ORTIZ, Bruno B.; CORRELL, Christoph U.; NOTO, Cristiano; CORDEIRO, Quirino; FREITAS, Rosana de; ELKIS, Helio; I, Sintia Belangero; BRESSAN, Rodrigo A.; GADELHA, AryBackground: Dimensional approaches can decompose a construct in a set of continuous variables, improving the characterization of complex phenotypes, such as schizophrenia. However, the five-factor model of the Positive and Negative Syndrome Scale (PANSS), the most used instrument in schizophrenia research, yielded poor fits in most confirmatory factor analysis (CFA) studies, raising concerns about its applications. Thus, we aimed to identify dimensional PANSS CFA models with good psychometric properties by comparing the traditional CFA with three methodological approaches: Bayesian CFA, multilevel modeling, and Multiple Indicators Multiple Causes (MIMIC) modeling.Methods: Clinical data of 700 schizophrenia patients from four centers were analyzed. We first performed a traditional CFA. Next, we tested the three techniques: 1) a Bayesian CFA; 2) a multilevel analysis using the centers as level; and 3) a MIMIC modeling to evaluate the impact of clinical staging on PANSS factors and items. Results: CFA and Bayesian CFA produced poor fit models. However, when adding a multilevel structure to the CFA model, a good fit model emerged. MIMIC modeling yielded significant differences in the factor structure between the clinical stages of schizophrenia. Sex, age, age of onset, and duration of illness did not significantly affect the model fit.Conclusion: Our comparison of different CFA methods highlights the need for multilevel structure to achieve a good fit model and the potential utility of staging models (rather than the duration of illness) to deal with clinical heterogeneity in schizophrenia. Large prospective samples with biological data should help to understand the interplay between psychometrics concerns and neurobiology research.
- An International Adult Guideline for Making Clozapine Titration Safer by Using Six Ancestry-Based Personalized Dosing Titrations, CRP, and Clozapine Levels(2022) LEON, Jose de; SCHORETSANITIS, Georgios; SMITH, Robert L.; MOLDEN, Espen; SOLISMAA, Anssi; SEPPALA, Niko; KOPECEK, Miloslav; SVANCER, Patrik; OLMOS, Ismael; RICCIARDI, Carina; IGLESIAS-GARCIA, Celso; MASMOUDI, Rim; SAFFIAN, Shamin Mohd; LEUNG, Jonathan G.; BUCKLEY, Peter F.; MARDER, Stephen R.; CITROME, Leslie; FREUDENREICH, Oliver; CORRELL, Christoph U.; MULLER, Daniel J.; YAGOOGLU, A. Elif Anil; RADULESCU, Flavian S.; CUBALA, Wieslaw J.; IGLESIAS-ALONSO, Ana; SPINA, Edoardo; RUAN, Can-Jun; WANG, Chuan-Yue; WANG, Gang; TANG, Yi-Lang; LIN, Shih-Ku; LANE, Hsien-Yuan; KIM, Yong Sik; KIM, Se Hyun; RAJKUMAR, Anto P.; GONZALEZ-ESQUIVEL, Dinora F.; JUNG-COOK, Helgi; BAPTISTA, Trino; ROHDE, Christopher; NIELSEN, Jimmi; VERDOUX, Helene; QUILES, Clelia; SANZ, Emilio J.; CUEVAS, Carlos De las; COHEN, Dan; SCHULTE, Peter F. J.; ERTUGRUL, Aygun; CHOPRA, Nitin; MCCOLLUM, Betsy; SHELTON, Charles; COTES, Robert O.; KAITHI, Arun R.; KANE, John M.; FAROOQ, Saeed; NG, Chee H.; BILBILY, John; HIEMKE, Christoph; LOPEZ-JARAMILLO, Carlos; MCGRANE, Ian; LANA, Fernando; EAP, Chin B.; ARROJO-ROMERO, Manuel; SEIFRITZ, Erich; EVERY-PALMER, Susanna; BOUSMAN, Chad A.; BEBAWI, Emmanuel; BHATTACHARYA, Rahul; KELLY, Deanna L.; OTSUKA, Yuji; LAZARY, Judit; TORRES, Rafael; YECORA, Agustin; MOTUCA, Mariano; CHAN, Sherry K. W.; ZOLEZZI, Monica; OUANES, Sami; BERARDIS, Domenico De; GROVER, Sandeep; PROCYSHYN, Ric M.; ADEBAYO, Richard A.; KIRILOCHEV, Oleg O.; SOLOVIEV, Andrey; FOUNTOULAKIS, Konstantinos N.; WILKOWSKA, Alina; AYUB, Muhammad; SILVA, Alzira; BONELLI, Raphael M.; VILLAGRAN-MORENO, Jose M.; CRESPO-FACORRO, Benedicto; TEMMINGH, Henk; DECLOEDT, Eric; PEDRO, Maria R.; TAKEUCHI, Hiroyoshi; TSUKAHARA, Masaru; GRUENDER, Gerhard; SAGUD, Marina; CELOFIGA, Andreja; RISTIC, Dragana Ignjatovic; ORTIZ, Bruno B.; ELKIS, Helio; PALHA, Antonio J. Pacheco; LLERENA, Adrian; FERNANDEZ-EGEA, Emilio; SISKIND, Dan; WEIZMAN, AbrahamThis international guideline proposes improving clozapine package inserts worldwide by using ancestry-based dosing and titration. Adverse drug reaction (ADR) databases suggest that clozapine is the third most toxic drug in the United States (US), and it produces four times higher worldwide pneumonia mortality than that by agranulocytosis or myocarditis. For trough steady-state clozapine serum concentrations, the therapeutic reference range is narrow, from 350 to 600 ng/mL with the potential for toxicity and ADRs as concentrations increase. Clozapine is mainly metabolized by CYP1A2 (female non-smokers, the lowest dose; male smokers, the highest dose). Poor metabolizer status through phenotypic conversion is associated with co-prescription of inhibitors (including oral contraceptives and valproate), obesity, or inflammation with C-reactive protein (CRP) elevations. The Asian population (Pakistan to Japan) or the Americas' original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/mL. In the US, daily doses of 300-600 mg/day are recommended. Slow personalized titration may prevent early ADRs (including syncope, myocarditis, and pneumonia). This guideline defines six personalized titration schedules for inpatients: 1) ancestry from Asia or the original people from the Americas with lower metabolism (obesity or valproate) needing minimum therapeutic dosages of 75-150 mg/day, 2) ancestry from Asia or the original people from the Americas with average metabolism needing 175-300 mg/day, 3) European/Western Asian ancestry with lower metabolism (obesity or valproate) needing 100-200 mg/day, 4) European/Western Asian ancestry with average metabolism needing 250-400 mg/day, 5) in the US with ancestries other than from Asia or the original people from the Americas with lower clozapine metabolism (obesity or valproate) needing 150-300 mg/day, and 6) in the US with ancestries other than from Asia or the original people from the Americas with average clozapine metabolism needing 300-600 mg/day. Baseline and weekly CRP monitoring for at least four weeks is required to identify any inflammation, including inflammation secondary to clozapine rapid titration.
- Negative dimension stability across clinical stages and sociodemographic characteristics in schizophrenia(2022) KOGA, Gabriela; HAGUIARA, Bernardo; ORTIZ, Bruno; NOTO, Cristiano; FREITAS, Rosana Ramos; ELKIS, Helio; BRESSAN, Rodrigo; ZIEBOLD, Carolina; GADELHA, Ary
- An International Adult Guideline for Making Clozapine Titration Safer by Using Six Ancestry-Based Personalized Dosing Titrations, CRP, and Clozapine Levels (10.1055/a-1625-6388)(2022) LEON, Jose de; SCHORETSANITIS, Georgios; SMITH, Robert L.; MOLDEN, Espen; SOLISMAA, Anssi; SEPPALA, Niko; KOPECEK, Miloslav; SVANCER, Patrik; OLMOS, Ismael; RICCIARDI, Carina; IGLESIAS-GARCIA, Celso; MARDER, Stephen R.; CITROME, Leslie; FREUDENREICH, Oliver; CORRELL, Christoph U.; MULLER, Daniel J.; YAGCIOGLU, A. Elif Anil; RADULESCU, Flavian S.; CUBALA, Wieslaw J.; IGLESIAS-ALONSO, Ana; SPINA, Edoardo; RUAN, Can-Jun; WANG, Chuan-Yue; WANG, Gang; TANG, Yi-Lang; LIN, Shih-Ku; LANE, Hsien-Yuan; KIM, Yong Sik; KIM, Se Hyun; RAJKUMAR, Anto P.; GONZALEZ-ESQUIVEL, Dinora F.; JUNG-COOK, Helgi; BAPTISTA, Trino; ROHDE, Christopher; NIELSEN, Jimmi; VERDOUX, Helene; QUILES, Clelia; SANZ, Emilio J.; CUEVAS, Carlos De las; COHEN, Dan; SCHULTE, Peter F. J.; ERTUGRUL, Aygun; CHOPRA, Nitin; MCCOLLUM, Betsy; SHELTON, Charles; COTES, Robert O.; KAITHI, Arun R.; KANE, John M.; FAROOQ, Saeed; NG, Chee H.; BILBILY, John; HIEMKE, Christoph; LOPEZ-JARAMILLO, Carlos; MCGRANE, Ian; LANA, Fernando; EAP, Chin B.; ARROJO-ROMERO, Manuel; SEIFRITZ, Erich; EVERY-PALMER, Susanna; BOUSMAN, Chad A.; BEBAWI, Emmanuel; BHATTACHARYA, Rahul; KELLY, Deanna L.; OTSUKA, Yuji; LAZARY, Judit; TORRES, Rafael; YECORA, Agustin; MOTUCA, Mariano; CHAN, Sherry K. W.; ZOLEZZI, Monica; OUANES, Sami; BERARDIS, Domenico De; GROVER, Sandeep; PROCYSHYN, Ric M.; ADEBAYO, Richard A.; KIRILOCHEV, Oleg O.; SOLOVIEV, Andrey; FOUNTOULAKIS, Konstantinos N.; WILKOWSKA, Alina; AYUB, Muhammad; SILVA, Alzira; BONELLI, Raphael M.; VILLAGRAN-MORENO, Jose M.; CRESPO-FACORRO, Benedicto; TEMMINGH, Henk; DECLOEDT, Eric; PEDRO, Maria R.; TAKEUCHI, Hiroyoshi; TSUKAHARA, Masaru; GRUENDER, Gerhard; SAGUD, Marina; CELOFIGA, Andreja; RISTIC, Dragana Ignjatovic; ORTIZ, Bruno B.; ELKIS, Helio; PALHA, Antonio J. Pacheco; LLERENA, Adrian; FERNANDEZ-EGEA, Emilio; SISKIND, Dan; WEIZMAN, Abraham; MASMOUDI, Rim; SAFFIAN, Shamin Mohd; LEUNG, Jonathan G.; BUCKLEY, Peter F.