LETICIA BARBOSA KAWANO DOURADO
Projetos de Pesquisa
Unidades Organizacionais
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
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- Methotrexate and rheumatoid arthritis associated interstitial, Lung disease(2021) JUGE, Pierre-Antoine; LEE, Joyce S.; LAU, Jessica; KAWANO-DOURADO, Leticia; SERRANO, Jorge Rojas; SEBASTIANI, Marco; KODURI, Gouri; MATTESON, Eric; BONFIGLIOLI, Karina; SAWAMURA, Marcio; KAIRALLA, Ronaldo; CAVAGNA, Lorenzo; CASSIONE, Emanuele Bozzalla; MANFREDI, Andreina; MEJIA, Mayra; RODRIGUEZ-HENRIQUEZ, Pedro; GONZALEZ-PEREZ, Montserrat I.; FALFAN-VALENCIA, Ramces; BUENDIA-ROLDAN, Ivette; PEREZ-RUBIO, Gloria; EBSTEIN, Esther; GAZAL, Steven; BORIE, Raphael; OTTAVIANI, Sebastien; KANNENGIESSER, Caroline; WALLAERT, Benoit; UZUNHAN, Yurdagul; NUNES, Hilario; VALEYRE, Dominique; SAIDENBERG-KERMANAC, Nathalie; BOISSIER, Marie-Christophe; WEMEAU-STERVINOU, Lidwine; FLIPO, Rene-Marc; MARCHAND-ADAM, Sylvain; RICHETTE, Pascal; ALLANORE, Yannick; DROMER, Claire; TRUCHETET, Marie-Elise; RICHEZ, Christophe; SCHAEVERBEKE, Thierry; LIOTE, Huguette; THABUT, Gabriel; DEANE, Kevin D.; SOLOMON, Joshua J.; DOYLE, Tracy; RYU, Jay H.; ROSAS, Ivan; HOLERS, V. Michael; BOILEAU, Catherine; DEBRAY, Marie-Pierre; PORCHER, Raphael; SCHWARTZ, David A.; VASSALLO, Robert; CRESTANI, Bruno; DIEUDE, PhilippeQuestion addressed by the study: Methotrexate (MTX) is a key anchor drug for rheumatoid arthritis (RA) management. Fibrotic interstitial lung disease (ILD) is a common complication of RA. Whether MTX exposure increases the risk of ILD in patients with RA is disputed. We aimed to evaluate the association of prior MTX use with development of RA-ILD. Methods: Through a case-control study design with discovery and international replication samples, we examined the association of MTX exposure with ILD in 410 patients with chronic fibrotic ILD associated with RA (RA-ILD) and 673 patients with RA without ILD. Estimates were pooled over the different samples using meta-analysis techniques. Results: Analysis of the discovery sample revealed an inverse relationship between MTX exposure and RA-ILD (adjusted OR 0.46, 95% CI 0.24 0.90; p=0.022), which was confirmed in the replication samples (pooled adjusted OR 0.39, 95% CI 0.19 -0.79; p=0.009). The combined estimate using both the derivation and validation samples revealed an adjusted OR of 0.43 (95% CI 0.26 0.69; p=0.0006). MTX ever-users were less frequent among patients with RA-ILD compared to those without II,D, irrespective of chest high-resolution computed tomography pattern. In patients with RA-ILD, ILD detection was significantly delayed in MTX ever-users compared to never-users (11.4 +/- 10.4 years and 4.0 +/- 7.4 years, respectively; p<0.001). Answer to the question: Our results suggest that MTX use is not associated with an increased risk of RA-ILD in patients with RA, and that ILD was detected later in MTX-treated patients.
- Prognostic factors associated with mortality in acute exacerbations of idiopathic pulmonary fibrosis: A systematic review and meta-analysis(2024) PITRE, Tyler; LUPAS, Daniel; EBEIDO, Ibrahim; COLAK, Alexander; MODI, Mihir; KACHKOVSKI, George V.; MONTESI, Sydney B.; KHOR, Yet H.; KAWANO-DOURADO, Leticia; JENKINS, Gisli; FISHER, Jolene H.; SHAPERA, Shane; ROCHWERG, Bram; COUBAN, Rachel; ZERAATKAR, DenaBackground: Acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) increases mortality risk, but which factors increase mortality is unknown. We aimed to perform a prognostic review of factors associated with mortality in patients with IPF. Study design: and methods: We searched MEDLINE, EMBASE, and CINAHL for studies that reported on the association between any prognostic factor and AE-IPF. We assessed risk of bias using the QUIPS tool. We conduced pairwise meta -analyses using REML heterogeneity estimator, and GRADE approach to assess the certainty of the evidence. Results: We included 35 studies in our analysis. We found that long-term supplemental oxygen at baseline (aHR 2.52 [95 % CI 1.68 to 3.80]; moderate certainty) and a diagnosis of IPF compared to non-IPF ILD (aHR 2.19 [95 % CI 1.22 to 3.92]; moderate certainty) is associated with a higher risk of death in patients with AE-IPF. A diffuse pattern on high resolution computed tomography (HRCT) compared to a non -diffuse pattern (aHR 2.61 [95 % CI 1.32 to 2.90]; moderate certainty) is associated with a higher risk of death in patients with AE-IPF. We found that using corticosteroids prior to hospital admission (aHR 2.19 [95 % CI 1.26 to 3.82]; moderate certainty) and those with increased neutrophils (by % increase) in bronchoalveolar lavage (BAL) during the exacerbation is associated with a higher risk of death (aHR 1.02 [1.01 to 1.04]; moderate certainty). Interpretation: Our results have implications for healthcare providers in making treatment decisions and prognosticating the clinical trajectory of patients, for researchers to design future interventions to improve patient trajectory, and for guideline developers in making decisions about resource allocation.
- A living WHO guideline on drugs to prevent covid-19(2021) LAMONTAGNE, Francois; AGORITSAS, Thomas; SIEMIENIUK, Reed; ROCHWERG, Bram; BARTOSZKO, Jessica; ASKIE, Lisa; MACDONALD, Helen; AMIN, Wagdy; BAUSCH, Frederique Jacquerioz; BURHAN, Erlina; CECCONI, Maurizio; CHANDA, Duncan; Vu Quoc Dat; DU, Bin; GEDULD, Heike; GEE, Patrick; NERINA, Harley; HASHIMI, Madiha; HUNT, Beverley J.; KABRA, Sushil; KANDA, Seema; KAWANO-DOURADO, Leticia; KIM, Yae-Jean; KISSOON, Niranjan; KWIZERA, Arthur; LEO, Yee-Sin; MAHAKA, Imelda; MANAI, Hela; MINO, Greta; NSUTEBU, Emmanuel; PSHENICHNAYA, Natalia; QADIR, Nida; RANGANATHAN, Shalini Sri; SABZWARI, Saniya; SARIN, Rohit; SHARLAND, Michael; SHEN, Yinzhong; SOUZA, Joao Paulo; STEGEMANN, Miriam; UGARTE, Sebastian; VENKATAPURAM, Sridhar; VUYISEKA, Dubula; PRELLER, Jacobus; BRIGNARDELLO-PETERSEN, Romina; KUM, Elena; QASIM, Anila; ZERAATKAR, Dena; OWEN, Andrew; GUYATT, Gordon; LYTVYN, Lyubov; DIAZ, Janet; VANDVIK, Per Olav; JACOBS, MichaelCLINICAL QUESTION What is the role of drugs in preventing covid-19? WHY DOES THIS MATTER? There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19. RECOMMENDATION The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty). HOW THIS GUIDELINE WAS CREATED This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. UNDERSTANDING THE NEW RECOMMENDATION The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19. UPDATES This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. READERS NOTE This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity. Drugs could be used as prophylaxis to prevent covid-19 developing in those who are free from disease. Such drugs complement vaccines that, through developing immune responses to SARS-Cov-2, reduce the risk of developing covid-19 and its consequences. Drugs to prevent covid-19 could target whole populations, those at higher risk of becoming infected with SARS-CoV-2 (due to their work, social circumstances, or a particular exposure), or those at higher risk of death and poor outcomes if infected. There are 2610 trials investigating various drug interventions for covid-19 (see section on emerging evidence).1 This rapidly evolving evidence landscape requires trustworthy interpretation and expeditious clinical practice guidelines to inform clinicians, patients, governments, ministries and health administrators. This living guideline uses emerging evidence from RCTs on drugs to prevent covid-19 and complements the livingWHOguideline on drugs to treat covid-19.(2) The living network meta-analysis associated with this guideline will incorporate new trial data and allow for analysis of comparative effectiveness.3 Details of the network meta-analysis and other related publications are listed in box 1. We will also use additional relevant evidence on long term safety, prognosis, and patient values and preferences related to covid-19 treatments to inform the living guidance.
- A living WHO guideline on drugs for covid-19(2020) LAMONTAGNE, Francois; AGORITSAS, Thomas; MACDONALD, Helen; LEO, Yee-Sin; DIAZ, Janet; AGARWAL, Arnav; APPIAH, John Adabie; ARABI, Yaseen; BLUMBERG, Lucille; CALFEE, Carolyn S.; CAO, Bin; CECCONI, Maurizio; COOKE, Graham; DUNNING, Jake; GEDULD, Heike; GEE, Patrick; MANAI, Hela; HUI, David S.; KANDA, Seema; KAWANO-DOURADO, Leticia; KIM, Yae-Jean; KISSOON, Niranjan; KWIZERA, Arthur; LAAKE, Jon Henrik; MACHADO, Flavia R.; QADIR, Nida; SARIN, Rohit; SHEN, Yinzhong; ZENG, Linan; BRIGNARDELLO-PETERSEN, Romina; LYTVYN, Lyubov; SIEMIENIUK, Reed; ZERAATKAR, Dena; BARTOSZKO, Jessica; GE, Long; MAGUIRE, Brittany; ROCHWERG, Bram; GUYATT, Gordon; VANDVIK, Per OlavCLINICAL QUESTION What is the role of drug interventions in the treatment and prevention of covid-19? RECOMMENDATIONS The first version on this living guidance focuses on corticosteroids. It contains a strong recommendation for systemic corticosteroids in patients with severe and critical covid-19, and a weak or conditional recommendation against systemic corticosteroids in patients with non-severe covid-19. Corticosteroids are inexpensive and are on the World Health Organisation list of essential medicines. HOW this guideline was created This guideline reflects an innovative collaboration between the WHO and the MAGIC Evidence Ecosystem Foundation, driven byan urgent need for global collaboration to provide trustworthy and living covid-19 guidance. A standing international panel of content experts, patients, clinicians, and methodologists, free from relevant conflicts of interest, produce recommendations for clinical practice. The panel follows standards, methods, processes, and platforms for trustworthy guideline development using the GRADE approach. We apply an individual patient perspective while considering contextual factors (that is, resources, feasibility, acceptability, equity) for countries and healthcare systems. THE EVIDENCE A living systematic review and network meta-analysis, supported by a prospective meta-analysis, with data from eight randomised trials (7184 participants) found that systemic corticosteroids probably reduce 28 day mortality in patients with critical covid-19 (moderate certainty evidence; 87 fewer deaths per 1000 patients (95% confidence interval 124 fewer to 41 fewer)), and also in those with severe disease (moderate certainty evidence; 67 fewer deaths per 1000 patients (100 fewer to 27 fewer)). In contrast, systemic corticosteroids may increase the risk of death in patients without severe covid-19 (low certainty evidence; absolute effect estimate 39 more per 1000 patients, (12 fewer to 107 more)). Systemic corticosteroids probably reduce the need for invasive mechanical ventilation, and harms are likely to be minor (indirect evidence). UNDERSTANDING THE RECOMMENDATIONS The panel made a strong recommendation for use of corticosteroids in severe and critical covid-19 because there is a lower risk of death among people treated with systemic corticosteroids (moderate certainty evidence), and they believe that all or almost all fully informed patients with severe and critical covid-19 would choose this treatment. In contrast, the panel concluded that patients with non-severe covid-19 would decline this treatment because they would be unlikely to benefit and may be harmed. Moreover, taking both a public health and a patient perspective, the panel warned that indiscriminate use of any therapy for covid-19 would potentially rapidly deplete global resources and deprive patients who may benefit from it most as potentially lifesaving therapy. UPDATES This is a living guideline. Work is under way to evaluate other interventions. New recommendations will be published as updates to this guideline. READERS NOTE This is version 1 of the living guideline, published on 4 September (BMJ 2020;370:m3379) version 1. Updates will be labelled as version 2, 3 etc. When citing this article, please cite the version number. SUBMITTED August 28 ACCEPTED August 31
- Outcome measurement instrument selection for lung physiology in systemic sclerosis associated interstitial lung disease: A systematic review using the OMERACT filter 2.1 process(2021) ROOFEH, David; BARRATT, Shaney L.; WELLS, Athol U.; KAWANO-DOURADO, Leticia; TASHKIN, Donald; STRAND, Vibeke; SEIBOLD, James; PROUDMAN, Susanna; BROWN, Kevin K.; DELLARIPA, Paul F.; DOYLE, Tracy; LEONARD, Thomas; MATTESON, Eric L.; V, Chester Oddis; SOLOMON, Joshua J.; SPARKS, Jeffrey A.; VASSALLO, Robert; MAXWELL, Lara; BEATON, Dorcas; CHRISTENSEN, Robin; TOWNSEND, Whitney; KHANNA, DineshObjective: The Outcome Measures in Rheumatology (OMERACT) is a research organization focused on improving health care outcomes for patients with autoimmune and musculoskeletal diseases. The Connective Tissue Disease-Interstitial Lung Disease (CTD-ILD) Working Group on Lung Physiology is a group within OMERACT charged with identifying outcome measures that should be implemented in studies of patients with CTD-ILD. The OMERACT Filter 2.1 is an evidence-based algorithm used to identify outcome measures that are truthful, feasible, and able to discriminate between groups of interest. Our objective was to summate evidence (published literature, key opinion leader input, patient perspectives) that would influence the CTDILD Working Group's vote to accept or reject the use of two measures of lung physiology, the forced vital capacity (FVC) and the diffusion capacity of carbon monoxide (DLco) for use in randomized controlled trials (RTCs) and longitudinal observational studies (LOSs) involving patients with systemic sclerosis associated ILD (SSc-ILD). Methods: Patient Research Partners (those afflicted with SSc-ILD) and the CTD-ILD Working Group on Lung Physiology were polled to assess their opinion on the FVC and DLco in terms of feasibility; the CTD-ILD Working Group was also queried on these instruments' face and content validity. We then conducted a systematic literature review to identify articles in the SSc-ILD population that assessed the following measurement properties of FVC and DLco: (1) construct validity, (2) test-retest reliability, (3) longitudinal construct validity, (4) clinical trial discrimination/sensitivity to detect change in clinical trials, and (5) thresholds of meaning. Results were summarized in a Summary of Measurement Properties (SOMP) table for each instrument. OMERACT CTD-ILD Working Group members discussed and voted on the strength of evidence supporting these two instruments and voted to endorse, provisionally endorse, or not endorse either instrument. Results: Forty Patient Research Partners reported these two measures are feasible (are not an unnecessary burden or represent an infeasible longitudinal assessment of their disease). A majority of the 18 CTD-ILD Working Group members voted that both the FVC and DLco are feasible and have face and content validity. The systematic literature review returned 1,447 non-duplicated articles, of which 177 met eligibility for full text review. Forty-eight studies (13 RCTs, 35 LOSs) were included in the qualitative analysis. The FVC SOMP table revealed high quality, consistent data with evidence of good performance for all five measurement properties, suggesting requisite published evidence to proceed with endorsement. The DLco SOMP table showed a lack of data to support test-retest reliability and inadequate evidence to support clinical trial discrimination. There was unanimous agreement (15 [100%]) among voting CTD-ILD Working Group members to endorse the FVC as an instrument for lung physiology in RCTs and LOSs in SSc-ILD. Based on currently available evidence, DLco did not meet the OMERACT criteria and is not recommended for use in RCTs to represent lung physiology of SSc-ILD. The OMERACT Technical Advisory Group agreed with these decisions. Conclusion: The OMERACT Filter 2.1 was successfully applied to the domain of lung physiology in patients with SSc-ILD. The FVC was endorsed for use in RCTs and LOSs based on the Working Group's vote; DLco was not endorsed.
- Systemic sclerosis associated interstitial lung disease: a conceptual framework for subclinical, clinical and progressive disease(2023) ROOFEH, David; BROWN, Kevin K.; KAZEROONI, Ella A.; TASHKIN, Donald; ASSASSI, Shervin; MARTINEZ, Fernando; WELLS, Athol U.; RAGHU, Ganesh; DENTON, Christopher P.; CHUNG, Lorinda; HOFFMANN-VOLD, Anna-Maria; DISTLER, Oliver; JOHANNSON, Kerri A.; ALLANORE, Yannick; MATTESON, Eric L.; KAWANO-DOURADO, Leticia; PAULING, John D.; SEIBOLD, James R.; VOLKMANN, Elizabeth R.; WALSH, Simon L. F.; V, Chester Oddis; WHITE, Eric S.; BARRATT, Shaney L.; BERNSTEIN, Elana J.; DOMSIC, Robyn T.; DELLARIPA, Paul F.; CONWAY, Richard; ROSAS, Ivan; BHATT, Nitin; HSU, Vivien; INGEGNOLI, Francesca; KAHALEH, Bashar; GARCHA, Puneet; GUPTA, Nishant; KHANNA, Surabhi; KORSTEN, Peter; LIN, Celia; MATHAI, Stephen C.; STRAND, Vibeke; DOYLE, Tracy J.; STEEN, Virginia; ZOZ, Donald F.; OVALLES-BONILLA, Juan; RODRIGUEZ-PINTO, Ignasi; SHENOY, Padmanabha D.; LEWANDOSKI, Andrew; BELLOLI, Elizabeth; LESCOAT, Alain; NAGARAJA, Vivek; YE, Wen; HUANG, Suiyuan; MAHER, Toby; KHANNA, DineshObjectives To establish a framework by which experts define disease subsets in systemic sclerosis associated interstitial lung disease (SSc-ILD). Methods A conceptual framework for subclinical, clinical and progressive ILD was provided to 83 experts, asking them to use the framework and classify actual SSc-ILD patients. Each patient profile was designed to be classified by at least four experts in terms of severity and risk of progression at baseline; progression was based on 1-year follow-up data. A consensus was reached if >= 75% of experts agreed. Experts provided information on which items were important in determining classification. Results Forty-four experts (53%) completed the survey. Consensus was achieved on the dimensions of severity (75%, 60 of 80 profiles), risk of progression (71%, 57 of 80 profiles) and progressive ILD (60%, 24 of 40 profiles). For profiles achieving consensus, most were classified as clinical ILD (92%), low risk (54%) and stable (71%). Severity and disease progression overlapped in terms of framework items that were most influential in classifying patients (forced vital capacity, extent of lung involvement on high resolution chest CT [HRCT]); risk of progression was influenced primarily by disease duration. Conclusions Using our proposed conceptual framework, international experts were able to achieve a consensus on classifying SSc-ILD patients along the dimensions of disease severity, risk of progression and progression over time. Experts rely on similar items when classifying disease severity and progression: a combination of spirometry and gas exchange and quantitative HRCT.
- METHOTREXATE AND RHEUMATOID ARTHRITIS ASSOCIATED INTERSTITIAL LUNG DISEASE(2020) JUGE, P. A.; LEE, J. S.; LAU, J.; KAWANO, L.; ROJAS-SERRANO, J.; SEBASTIANI, M.; KODURI, G.; MATTESON, E.; BONFIGLIOLI, K.; SAWAMURA, M.; KAIRALLA, R.; CAVAGNA, L.; CASSIONE, E. Bozzalla; MANFREDI, A.; MEJIA, M.; HENRIQUEZ, P. Rodriguez; GONZALEZ-PEREZ, M. I.; FALFAN-VALENCIA, R.; BUENDIA-ROLDAN, I.; PEREZ-RUBIO, G.; EBSTEIN, E.; GAZAL, S.; BORIE, R.; OTTAVIANI, S.; KANNENGIESSER, C.; WALLAERT, B.; UZUNHAN, Y.; NUNES, H.; VALEYRE, D.; KERMANAC'H, N. Saidenberg; BOISSIER, M. C.; STERVINOU, L. Wemeau; FLIPO, R. M.; MARCHAND-ADAM, S.; RICHETTE, P.; ALLANORE, Y.; DROMER, C.; TRUCHETET, M. E.; RICHEZ, C.; SCHAEVERBEKE, T.; LIOTE, H.; THABUT, G.; DEANE, K.; SOLOMON, J.; DOYLE, T.; RYU, J. H.; ROSAS, I. O.; HOLERS, V. M.; BOILEAU, C.; DEBRAY, M. P.; PORCHER, R.; SCHWARTZ, D. A.; VASSALLO, R.; CRESTANI, B.; DIEUDE, P.
- Systemic corticosteroids in fibrotic lung disease: a systematic review and meta-analysis(2023) PITRE, Tyler; KAWANO-DOURADO, Leticia; V, George Kachkovski; LEUNG, Darren; LEUNG, Gareth; DESAI, Kairavi; ZHAI, Chunjuan; ADAMS, Wendy; FUNKE-CHAMBOUR, Manuela; KREUTER, Michael; STEWART, Iain; RYERSON, Christopher J.; JENKINS, Gisli; ZERAATKAR, DenaObjectivesWe aimed to assess the available evidence for corticosteroids in fibrotic interstitial lung disease (fILD) to inform the randomised embedded multifactorial adaptive platform ILD.DesignSystematic review and meta-analysis.Data sourcesWe searched Embase, Medline, Cochrane CENTRAL and Web of Science databases from inception to April 17 2023.Eligibility criteriaWe included studies that compared corticosteroids with standard care, placebo or no treatment in adult patients with fILD.Data extraction and synthesisWe report on the change in forced vital capacity (FVC) and mortality. We used random-effects meta-analysis to estimate relative risk (RR) for dichotomous outcomes, and mean difference (MD) and standardised MDs for continuous outcomes, with 95% CIs.ResultsOf the 13 229 unique citations identified, we included 10 observational studies comprising 1639 patients. Corticosteroids had an uncertain effect on mortality compared with no treatment (RR 1.03 (95% CI 0.85 to 1.25); very low certainty evidence). The effect of corticosteroids on the rate of decline in FVC (% predicted) was uncertain when compared with no treatment (MD 4.29% (95% CI -8.26% to 16.83%); very low certainty evidence). However, corticosteroids might reduce the rate of decline in FVC in patients with non-idiopathic pulmonary fibrosis (IPF) fILD (MD 10.89% (95% CI 5.25% to 16.53%); low certainty evidence), while an uncertain effect was observed in patients with IPF (MD -3.80% (95% CI -8.94% to 1.34%); very low certainty evidence).ConclusionsThe current evidence on the efficacy and safety of corticosteroids in fILD is limited and of low certainty. Randomised trials are needed to address this significant research gap.