RICARDO ROMITI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/53 - Laboratório de Micologia, Hospital das Clínicas, Faculdade de Medicina
LIM/50 - Laboratório de Patologia das Moléstias Infecciosas, Hospital das Clínicas, Faculdade de Medicina
LIM/53 - Laboratório de Micologia, Hospital das Clínicas, Faculdade de Medicina
LIM/50 - Laboratório de Patologia das Moléstias Infecciosas, Hospital das Clínicas, Faculdade de Medicina
12 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 12
- Treatment of Psoriasis Patients with Latent Tuberculosis Using IL-17 and IL-23 Inhibitors: A Retrospective, Multinational, Multicentre Study(2024) TORRES, Tiago; CHIRICOZZI, Andrea; PUIG, Luis; LE, Ana Maria; MARZANO, Angelo Valerio; DAPAVO, Paolo; DAUDEN, Esteban; CARRASCOSA, Jose-Manuel; LAZARIDOU, Elizabeth; DUARTE, Gleison; CARVALHO, Andre V. E.; ROMITI, Ricardo; ROMPOTI, Natalia; TEIXEIRA, Laetitia; ABREU, Miguel; IPPOLITI, Elena; MARONESE, Carlo Alberto; LLAMAS-VELASCO, Mar; VILARRASA, Eva; ALCAZAR, Elena del; DAPONTE, Athina-Ioanna; PAPOUTSAKI, Marina; CARUGNO, Andrea; BELLINATO, Francesco; GISONDI, PaoloBackgroundTuberculosis has a major global impact. Immunocompetent hosts usually control this disease, resulting in an asymptomatic latent tuberculosis infection (LTBI). Because TNF inhibitors increase the risk of tuberculosis reactivation, current guidelines recommend tuberculosis screening before starting any biologic drug, and chemoprophylaxis if LTBI is diagnosed. Available evidence from clinical trials and real-world studies suggests that IL-17 and IL-23 inhibitors do not increase the risk of tuberculosis reactivation.ObjectiveTo evaluate psoriasis patients with treated or untreated newly diagnosed LTBI who received IL-17 and IL-23 inhibitors and the tolerability/safety of tuberculosis chemoprophylaxis.MethodsThis is a retrospective, observational, multinational study from a series of 14 dermatology centres based in Portugal, Spain, Italy, Greece and Brazil, which included adult patients with moderate-to-severe chronic plaque psoriasis and newly diagnosed LTBI who were treated with IL-23 or IL-17 inhibitors between January 2015 and March 2022. LTBI was diagnosed in the case of tuberculin skin test and/or interferon gamma release assay positivity, according to local guideline, prior to initiating IL-23 or IL-17 inhibitor. Patients with prior diagnosis of LTBI (treated or untreated) or treated active infection were excluded.ResultsA total of 405 patients were included; complete/incomplete/no chemoprophylaxis was administered in 62.2, 10.1 and 27.7% of patients, respectively. The main reason for not receiving or interrupting chemoprophylaxis was perceived heightened risk of liver toxicity and hepatotoxicity, respectively. The mean duration of biological treatment was 32.87 +/- 20.95 months, and only one case of active tuberculosis infection (ATBI) was observed, after 14 months of treatment with ixekizumab. The proportion of ATBI associated with ixekizumab was 1.64% [95% confidence interval (CI): 0-5.43%] and 0% for all other agents and 0.46% (95% CI 0-1.06%) and 0% for IL-17 and IL-23 inhibitors, respectively (not statistically significant).ConclusionsThe risk of tuberculosis reactivation in patients with psoriasis and LTBI does not seem to increase with IL-17 or IL-23 inhibitors. IL-17 or IL-23 inhibitors should be preferred over TNF antagonists when concerns regarding tuberculosis reactivation exists. In patients with LTBI considered at high risk for developing complications related to chemoprophylaxis, this preventive strategy may be waived before initiating treatment with IL-17 inhibitors and especially IL-23 inhibitors.
conferenceObject Psoriasis And Mental Health Comorbidities: A Multinational Analysis Using the Global Healthcare Study on Psoriasis (GHSP)(2023) PETERSON, Hannah; KOROURI, Edwin; KINGSTON, Paige; LEE, Kathryn; HUANG, Margaret; YEE, Danielle; AGUERO, Rosario; ARTIGA, Kevin; VALENZUELA, Fernando; ROMITI, Ricardo; DIDASKALU, Johannes; EGEBERG, Alexander; OON, Hazel H.; MAUL, Julia-Tatjana; ARMSTRONG, April W.- Prevalence of psoriasis and other autoimmune skin diseases in a recently contacted indigenous community in the Auaris region, Yanomami Indigenous Territory, Brazil(2023) ROMITI, Ricardo; MARTINS, Luciana P. F.; SANTANA, Yago R. T.; TIMBO, Renata V.; KURIZKY, Patricia S.; BARROSO, Daniel H.; ANDRADE, Rafael R. De; GOMES, Ciro M.; GRIFFITHS, Christopher E. M.
- Rational evaluation of patients with COVID-19-related hair loss(2022) REZENDE, Hudson Dutra; MINARI, Gabriela; CUNHA, Marcele; DINATO, Sandra; DIAS, Maria Fernanda Reis Gavazzoni; ROMITI, Ricardo
- Diversity in the clinical presentation of generalized pustular psoriasis (GPP): A series of case vignettes from around the world(2023) CHOON, Siew Eng; ELEWSKI, Boni E.; FUJITA, Hideki; GENG, Songmei; KERKHOF, Peter van de; MBURU, Sicily; PUIG, Lluis; ROMITI, Ricardo; VENTURINI, MarinaA key principle of clinical studies and case reports is that they should reflect the demographics and epidemiology of the patient population concerned. Here, we have compiled a diverse group of clinical cases of generalized pustular psoriasis (GPP) to showcase the differences in GPP presentation in patients worldwide. We attempt to capture the broad spectrum of clinical presentations of GPP and showcase the diversity of the patient population. The patients included in this series are diverse in age, genetic background, skin phototype and medical history. Moreover, they present with a variety of clinical courses of GPP and different degrees of systemic involvement, and experience flares triggered by different inciting factors. The key learnings from this case series may support physicians in identifying and managing patients with this rare and multifaceted disease that can affect patients both physically and psychologically.
- Sensitive Scalp and Trichodynia: Epidemiology, Etiopathogenesis, Diagnosis, and Management(2023) SOUZA, Emilly Neves; ANZAI, Alessandra; FECHINE, Carolina Oliveira Costa; VALENTE, Neusa Yuriko Sakai; ROMITI, RicardoSensitive scalp (SSc) is considered a sensitive skin on the scalp, with its particularities. Although it is not rare in the dermatological practice and the term is commonly present in personal care products, this entity is poorly investigated in the medical literature. The etiopathogenesis is still uncertain, and the sensitivity may be associated with hair loss. Clinical manifestations are subjective symptoms of pruritus, burning, pain, pricking, and/or trichodynia, often with scalp erythema. SSc can be triggered by several factors (endogenous or exogenous). The diagnosis is guided by the anamnesis, and there are still no specific trichoscopic features. Trigeminal trophic syndrome and postherpetic neuralgia are the main differential diagnosis to be considered. We organized the therapeutical approach in three steps: scalp care, topical and systemic treatment.
- Generalized pustular psoriasis: A global Delphi consensus on clinical course, diagnosis, treatment goals and disease management(2023) PUIG, Lluis; CHOON, Siew Eng; GOTTLIEB, Alice B. B.; MARRAKCHI, Slaheddine; PRINZ, Joerg C.; ROMITI, Ricardo; TADA, Yayoi; BREDOW, Dorothea von; GOODERHAM, MelindaBackgroundGeneralized pustular psoriasis (GPP) is a rare and highly heterogeneous skin disease, characterized by flares of neutrophilic pustules and erythema. As a rare disease with few clinical studies and no standardized management approaches, there is a paucity of knowledge regarding GPP. ObjectivesConduct a Delphi panel study to identify current evidence and gain advanced insights into GPP. MethodsA systematic literature review was used to identify published literature and develop statements categorized into four key domains: clinical course and flare definition; diagnosis; treatment goals; and holistic management. Statements were rated on a Likert scale by a panel of dermatologists in two rounds of online questionnaires; the threshold for consensus was agreement by >= 80%. ResultsTwenty-one panellists reached consensus on 70.9%, 61.8%, 100.0% and 81.8% of statements in the 'clinical course and flare definition', 'diagnosis', 'treatment goals' and 'holistic management of GPP' domains, respectively. There was clear consensus on GPP being phenotypically, genetically and immunologically distinct from plaque psoriasis. Clinical course is highly variable, with an extensive range of complications. Clinical and histologic features supporting GPP diagnosis reached high levels of agreement, and although laboratory evaluations were considered helpful for diagnosis and monitoring disease severity, there was uncertainty around the value of individual tests. All acute and long-term treatment goals reached consensus, including rapid and sustained clearance of pustules, erythema, scaling and crust, clearance of skin lesions and prevention of new flares. Potential triggers, associated comorbidities and differential diagnoses achieved low rates of consensus, indicating that further evidence is needed. ConclusionsGlobal consensus between dermatologists was reached on clinically meaningful goals for GPP treatment, on key features of GPP flares and on approaches for assessing disease severity and multidisciplinary management of patients. On this basis, we present a management algorithm for patients with GPP for use in clinical practice.
- Access to psoriasis treatment in Brazil and Chile: A cross-sectional multicentre Global Healthcare Study on Psoriasis(2023) MAUL, Julia-Tatjana; FROEHLICH, Fabienne; MAUL, Lara Valeska; STUNNENBERG, Rieka; VALENZUELA, Fernando; CRUZ, Claudia De La; VERA-KELLET, Cristian; ARMIJO, Daniela; CESAR, Wagner G.; CARVALHO, Andre; DIDASKALU, Johannes Alexander; GRAF, Nicole; EGEBERG, Alexander; WU, Jashin J.; THYSSEN, Jacob P.; ROMITI, Ricardo; GRIFFITHS, Christopher E. M.Background Sufficient data on access to systemic treatment for patients with psoriasis living in Latin America (LA) including Brazil and Chile are lacking. Understanding the availability and limiting factors of access to treatments can help to improve patient care and decrease long-term healthcare costs. Objectives In association with the Global Psoriasis Atlas, this cross-sectional survey study analysed the availability and insurance reimbursement of systemic treatments for adult patients with psoriasis in Brazil and Chile. Methods A multicentre, cross-sectional Global Healthcare Study on Psoriasis was performed in Brazil and Chile in 2020. For each eligible adult patient with psoriasis, doctors and nurses completed a 48-item questionnaire about clinical aspects of psoriasis including the Psoriasis Area Severity Index (PASI), body surface area (BSA) score and the Dermatology Life Quality Index (DLQI), as well as the availability of systemic treatments and insurance reimbursement status. Between-country differences were compared with Wilcoxon rank sum tests for continuous variables, and a chi(2)-test or Fisher's exact test, where appropriate, for categorical variables. The median and interquartile range (IQR) was calculated for non-normal distributed data. Results A total of 1424 patients with psoriasis from 43 centres [27 centres in Brazil (n = 826) and 16 in Chile (n = 598)], were included with a mean (SD) age of 49.1 (16.3) and 49.2 (15.1) years, respectively. Unstratified analyses revealed that patients with psoriasis in Chile had more severe disease than those in Brazil [PASI 11.6 vs. 8.4 (P < 0.001) and BSA 14.7 vs. 12.0 (P = 0.003), respectively]. For patients with moderate-to-severe psoriasis, defined as PASI and/or BSA >= 10, systemic nonbiologic drugs were available (81.2% in Brazil and 65.3% in Chile, P <= 0.001), but only 37.0% of patients in Brazil and 27.3% in Chile received biologics (P = 0.01). Lack of availability and/or lack of insurance reimbursement for biologic drugs for patients with moderate-to-severe psoriasis was reported for 22.2% (50 of 225) in Brazil and 67.9% (148 of 218) in Chile (P < 0.001). Patients with no access to biologic therapies due to lack of availability/insurance reimbursement had a median PASI of 9.15 (IQR 3.00-14.25) in Brazil and 12.0 (IQR 5.00-19.00) in Chile (P = 0.007), as well as a median BSA of 7.0 (IQR 3.00-15.00) and 12.0 (IQR 5.00-22.50) (P = 0.002), and median DLQI of 11.0 (6.00-15.00) and 21.0 (6.50-25.00) (P = 0.007), respectively. Conclusions Chilean patients had significantly more severe psoriasis compared with Brazilian patients in our study. While nonbiologic treatments for moderate-to-severe psoriasis were available in both LA countries, there is a high need for improvement in access to more effective psoriasis treatments including biologics. Our results highlight a significant gap between treatment recommendations in international psoriasis guidelines and real-world situations in Brazil and Chile.
- Correlation between Dermatology Life Quality Index and Psoriasis Area and Severity Index in Patients with Psoriasis: A Cross-sectional Global Healthcare Study on Psoriasis(2024) MAUL, Julia-Tatjana; V, Lara Maul; DIDASKALU, Johannes A.; VALENZUELA, Fernando; ROMITI, Ricardo; PETERSON, Hannah; KOROURI, Edwin; NOVOA, Farah; OON, Hazel H.; ZHENG, Min; WU, Jashin J.; THYSSEN, Jacob P.; EGEBERG, Alexander; ARMSTRONG, April W.; NIELSEN, Mia-LouiseQuality of life impairment in dermatology patients and severity of psoriasis are quantified by the Dermatology Life Quality Index (DLQI) and the Psoriasis Area and Severity Index (PASI), respectively. The aim of this study is to compare the correlation between PASI and DLQI in patients from different geographical areas and to identify predictors of high DLQI across geographical regions. Correlations between PASI and DLQI were evaluated using Spearman's rank correlation tests and quantile regression. The study included 1,158 patients with psoriasis, with a median (interquartile range) PASI and DLQI of 6.0 (3.0-12.0) and 8.0 (4.0-15.0), respectively. Correlations were demonstrated between PASI and DLQI, both overall and stratified by geographical region. Quantile (median) regression yielded coefficients of 0.75 (95% confidence interval (95% CI) 0.62, 0.88) for Switzerland, 0.50 (95% CI 0.42, 0.58) for Latin America, 0.34 (95% CI 0.16, 0.51) for Asia, and 0.31 (95% CI 0.08, 0.53) for the USA. Current age, age at diagnosis, sex, body mass index, and psoriasis arthritis affected DLQI in Latin America, while education had an impact among patients treated in Switzerland. Few countries were included within each continent; hence, more data from different countries are necessary for generalizability. The study showed correlations between PASI and DLQI among patients in all included geographical regions. The patients' characteristics affecting DLQI vary worldwide.
conferenceObject Correlation between DLQI and PASI in patients with psoriasis - a cross-sectional Global Healthcare Study on Psoriasis (GHSP)(2023) NIELSEN, Mia-Louise; MAUL, Lara Valeska; DIDASKALU, Johannes A.; VALENZUELA, Fernando; ROMITI, Ricardo; GRIFFITHS, Christopher E. M.; NOVOA, Farah; OON, Hazel H.; EGEBERG, Alexander; ARMSTRONG, April W.; MAUL, Julia-Tatjana