ROBERTO TAKAOKA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
10 resultados
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Agora exibindo 1 - 10 de 10
- When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council(2017) SIMPSON, Eric L.; BRUIN-WELLER, Marjolein; FLOHR, Carsten; ARDERN-JONES, Michael R.; BARBAROT, Sebastien; DELEURAN, Mette; BIEBER, Thomas; VESTERGAARD, Christian; BROWN, Sara J.; CORK, Michael J.; DRUCKER, Aaron M.; EICHENFIELD, Lawrence F.; FOELSTER-HOLST, Regina; GUTTMAN-YASSKY, Emma; NOSBAUM, Audrey; REYNOLDS, Nick J.; SILVERBERG, Jonathan I.; SCHMITT, Jochen; SEYGER, Marieke M. B.; SPULS, Phyllis I.; STALDER, Jean-Francois; SU, John C.; TAKAOKA, Roberto; TRAIDL-HOFFMANN, Claudia; THYSSEN, Jacob P.; SCHAFT, Jorien van der; WOLLENBERG, Andreas; IRVINE, Alan D.; PALLER, Amy S.Background: Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking. Objective: To guide those considering use of systemic therapy in AD and provide a framework for evaluation before making this therapeutic decision with the patient. Methods: A subgroup of the International Eczema Council determined aspects to consider before prescribing systemic therapy. Topics were assigned to expert reviewers who performed a topic-specific literature review, referred to guidelines when available, and provided interpretation and expert opinion. Results: We recommend a systematic and holistic approach to assess patients with severe signs and symptoms of AD and impact on quality of life before systemic therapy. Steps taken before commencing systemic therapy include considering alternate or concomitant diagnoses, avoiding trigger factors, optimizing topical therapy, ensuring adequate patient/caregiver education, treating coexistent infection, assessing the impact on quality of life, and considering phototherapy. Limitations: Our work is a consensus statement, not a systematic review. Conclusion: The decision to start systemic medication should include assessment of severity and quality of life while considering the individual's general health status, psychologic needs, and personal attitudes toward systemic therapies.
- Report from the fourth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative)(2016) CHALMERS, J. R.; SIMPSON, E.; APFELBACHER, C. J.; THOMAS, K. S.; KOBYLETZKI, L. von; SCHMITT, J.; SINGH, J. A.; SVENSSON, A.; WILLIAMS, H. C.; ABUABARA, K.; AOKI, V.; ARDELEANU, M.; AWICI-RASMUSSEN, M.; BARBAROT, S.; BERENTS, T. L.; BLOCK, J.; BRAGG, A.; BURTON, T.; CLEMMENSEN, K. K. Bjerring; CRESWELL-MELVILLE, A.; DINESEN, M.; DRUCKER, A.; ECKERT, L.; FLOHR, C.; GARG, M.; GERBENS, L. A. A.; GRAFF, A. L. B.; HANIFIN, J.; HEINL, D.; HUMPHREYS, R.; ISHII, H. A.; KATAOKA, Y.; LESHEM, Y. A.; MARQUORT, B.; MASSUEL, M. -A.; MERHAND, S.; MIZUTANI, H.; MUROTA, H.; MURRELL, D. F.; NAKAHARA, T.; NASR, I.; NOGRALES, K.; OHYA, Y.; OSTERLOH, I.; PANDER, J.; PRINSEN, C.; PURKINS, L.; RIDD, M.; SACH, T.; SCHUTTELAAR, M. -L. A.; SHINDO, S.; SMIRNOVA, J.; SULZER, A.; GJERDE, E. Synnove; TAKAOKA, R.; TALMO, H. Vestby; TAUBER, M.; TORCHET, F.; VOLKE, A.; WAHLGREN, C. -F.; WEIDINGER, S.; WEISSHAAR, E.; WOLLENBERG, A.; YAMAGA, K.; ZHAO, C. Y.; SPULS, P. I.This article is a report of the fourth meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in Malmo, Sweden on 23-24 April 2015 (HOME IV). The aim of the meeting was to achieve consensus over the preferred outcome instruments for measuring patient-reported symptoms and quality of life for the HOME core outcome set for atopic eczema (AE). Following presentations, which included data from systematic reviews, consensus discussions were held in a mixture of whole group and small group discussions. Small groups were allocated a priori to ensure representation of different stakeholders and countries. Decisions were voted on using electronic keypads. For the patient-reported symptoms, the group agreed by vote that itch, sleep loss, dryness, redness/inflamed skin and irritated skin were all considered essential aspects of AE symptoms. Many instruments for capturing patient-reported symptoms were discussed [ including the Patient-Oriented SCOring Atopic Dermatitis index, Patient-Oriented Eczema Measure (POEM), Self-Administered Eczema Area and Severity Index, Itch Severity Scale, Atopic Dermatitis Quickscore and the Nottingham Eczema Severity Score] and, by consensus, POEM was selected as the preferred instrument to measure patient-reported symptoms. Further work is needed to determine the reliability and measurement error of POEM. Further work is also required to establish the importance of pain/soreness and the importance of collecting information regarding the intensity of symptoms in addition to their frequency. Much of the discussion on quality of life concerned the Dermatology Life Quality Index and Quality of Life Index for Atopic Dermatitis; however, consensus on a preferred instrument for measuring this domain could not be reached. In summary, POEM is recommended as the HOME core outcome instrument for measuring AE symptoms.
- Topical corticosteroid phobia in atopic dermatitis: International feasibility study of the TOPICOP score(2017) STALDER, J. -F.; AUBERT, H.; ANTHOINE, E.; FUTAMURA, M.; MARCOUX, D.; MORREN, M. -A.; TRZECIAK, M.; SZALAI, Z.; VERES, K.; DELEURAN, M.; VESTERGAARD, C.; BORALEVI, F.; CHU, C. -Y.; RAEVE, L. De; SVENSSON, A.; FOELSTER-HOLST, R.; BUCHNER, M.; TAKAOKA, R.; AOKI, V.; CHERNYSHOV, P.; CHERNYSHOVA, L.; MURRELL, D. F.; ZHAO, C.; MCKINSTER, C. D.; KOBYLETZKY, L. Von; EICHENFIELD, L.; TOTRI, C.; LIO, P.; SENESCHAL, J.; MORET, L.; BARBAROT, S.BackgroundAdherence to topical corticosteroids (TCS) is essential for the effective treatment of atopic dermatitis but can be limited by concerns about their use. This study examined the feasibility of applying the validated TOPICOP score for assessing TCS phobia across different countries. MethodsThis was a prospective multicentre feasibility study conducted in 21 hospitals in 17 countries. Patients >3 months of age with atopic dermatitis or their parents or legal representatives completed a validated translation of the TOPICOP questionnaire in the country's native language. Respondents also completed questionnaires collecting opinions about the feasibility and acceptability of the TOPICOP questionnaire. ResultsA total of 1564 participants in 15 countries were included in the analysis. 81% of respondents considered the questions clear or very clear, and 79% reported that it took less than 5 minutes to complete. Each of the individual items in the TOPICOP questionnaire was considered to be not at all difficult to answer by 49% to 74% of participants. The mean global TOPICOP score was 44.7%20.5. Mean TOPICOP subscores were 37.0 +/- 22.8% for knowledge and beliefs, 54.7 +/- 27.8% for fears and 50.1 +/- 29.1% for behaviours. Global scores and subscores differed between countries, although the subscores did not always vary in parallel, suggesting different levels of TCS phobia and different drivers for each country. ConclusionsThe TOPICOP score can be feasibly applied across countries and may therefore be useful for obtaining qualitative and quantitative data from international studies and for adapting patient education and treatment.
- Healthcare Disparities in Atopic Dermatitis in Latin America: A Narrative Review(2023) SANCHEZ, Jorge; ALE, Iris-Selva; ANGLES, Maria Valeria; FOGELBACH, Guillermo Guidos; JANSEN, Angela Marie; TAKAOKA, Roberto; BORZUTZKY, ArturoIntroduction: Atopic dermatitis (AD) is a chronic, pruritic skin disease caused by a mixture of genetic, immunological, and environmental factors, characterized by periods of inflammation and remission. In Latin America (LA), the prevalence of AD ranges up to 25% in children and 1-3% in adults. The natural history of the disease for most patients is that AD goes into remission in adolescence and adult life. Only 10-30% of patients continue to have symptoms of the disease in adulthood. There are patients (3-4%) who have the onset of AD during adolescence or after adulthood. Those with limited access to healthcare services, such as diagnosis and treatment, have increased difficulties coping with AD. Healthcare disparities are a complex topic that include social, political, racial/ethnic, and geographical factors. Publications about healthcare disparities in AD in LA are scarce. As a result, recognizing and resolving healthcare inequalities is critical to improving the treatment and quality of life (QoL) of individuals with AD. Methods: A panel of Latin American experts in dermatology and allergies was provided with a series of relevant questions to address before a multiday conference. During this conference, the entire group discussed and edited each narrative through numerous drafts and rounds of discussion until they reached a consensus. Results: This paper examines the barriers to equal access to care and recommends realistic actions to overcome them. Inadequate disease knowledge, cultural and linguistic barriers, stigmatization, maldistribution of resources, absence of local clinical practice guidelines, arduous patient journey, and limited consultation time were identified as causes of health inequality. Conclusions: Among the suggested solutions are enhanced education for healthcare professionals, patients, and the general public, a focus on underprivileged communities, telemedicine and telementoring, translators, multidisciplinary teams, and local living clinical practice guidelines.
- Global Allergy Forum and 3rd Davos Declaration 2015: Atopic dermatitis/Eczema: challenges and opportunities toward precision medicine(2016) BIEBER, T.; AKDIS, C.; LAUENER, R.; TRAIDL-HOFFMANN, C.; SCHMID-GRENDELMEIER, P.; SCHAEPPI, G.; ALLAM, J. -P.; APFELBACHER, C.; AUGUSTIN, M.; BECK, L.; BIEDERMANN, T.; BRAUN-FAHRLANDER, C.; CHEW, F. T.; CLAVEL, T.; CRAMERI, R.; DARSOW, U.; DELEURAN, M.; DITTLEIN, D.; DUCHNA, H. -W.; EICHENFELD, L.; EYERICH, K.; FREI, R.; GELMETTI, C.; GIELER, U.; GILLES, S.; GLATZ, M.; GRANDO, K.; GREEN, J.; GUTERMUTH, J.; GUTTMAN-YASSKY, E.; HANIFIN, J.; HIJNEN, D.; HOETZENECKER, W.; IRVINE, A.; KALWEIT, A.; KATOH, N.; KNOL, E.; KOREN, H.; MOHRENSCHLAGER, M.; MUENCH, D.; NOVAK, N.; O'MAHONY, L.; PALLER, A. S.; RHYNER, C.; RODUIT, C.; SCHIESSER, K.; SCHROEDER, J.; SIMON, D.; SIMON, H. -U.; SOKOLOWSKA, M.; SPULS, P.; STALDER, J. -F.; STRAUB, D.; SZALAI, Z.; TAIEB, A.; TAKAOKA, R.; TODD, G.; TODOROVA, A.; VESTERGAARD, C.; WERFEL, T.; WOLLENBERG, A.; RING, J.
- Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME)(2014) CHALMERS, J. R.; SCHMITT, J.; APFELBACHER, C.; DOHIL, M.; EICHENFIELD, L. F.; SIMPSON, E. L.; SINGH, J.; SPULS, P.; THOMAS, K. S.; ADMANI, S.; AOKI, V.; ARDELEANU, M.; BARBAROT, S.; BERGER, T.; BERGMAN, J. N.; BLOCK, J.; BOROK, N.; BURTON, T.; CHAMLIN, S. L.; DECKERT, S.; DEKLOTZ, C. C.; GRAFF, L. B.; HANIFIN, J. M.; HEBERT, A. A.; HUMPHREYS, R.; KATOH, N.; KISA, R. M.; MARGOLIS, D. J.; MERHAND, S.; MINNILLO, R.; MIZUTANI, H.; NANKERVIS, H.; OHYA, Y.; RODGERS, P.; SCHRAM, M. E.; STALDER, J. F.; SVENSSON, A.; TAKAOKA, R.; TEPER, A.; TOM, W. L.; KOBYLETZKI, L. von; WEISSHAAR, E.; ZELT, S.; WILLIAMS, H. C.This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6-7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient-reported symptoms, long-term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long-term control is needed before progress can be made towards recommending a core outcome measure.
- Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting(2012) SCHMITT, Jochen; SPULS, Phyllis; BOERS, Maarten; THOMAS, Kim; CHALMERS, Joanne; ROEKEVISCH, Evelien; SCHRAM, Mandy; ALLSOPP, Richard; AOKI, Valeria; APFELBACHER, Christian; BRUIJNZEEL-KOOMEN, Carla; BRUIN-WELLER, Marjolein; CHARMAN, Carolyn; COHEN, Arnon; DOHIL, Magdalene; FLOHR, Carsten; FURUE, Masutaka; GIELER, Uwe; HOOFT, Lotty; HUMPHREYS, Rosemary; ISHII, Henrique Akira; KATAYAMA, Ichiro; KOUWENHOVEN, Willem; LANGAN, Sinead; LEWIS-JONES, Sue; MERHAND, Stephanie; MUROTA, Hiroyuki; MURRELL, Dedee F.; NANKERVIS, Helen; OHYA, Yukihiro; ORANJE, Arnold; OTSUKA, Hiromi; PAUL, Carle; ROSENBLUTH, Yael; SAEKI, Hidehisa; SCHUTTELAAR, Marie-Louise; STALDER, Jean-Francois; SVENSSON, Ake; TAKAOKA, Roberto; WAHLGREN, Carl-Fredrik; WEIDINGER, Stephan; WOLLENBERG, Andreas; WILLIAMS, HywelThe use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research.
- Therapeutic Patient Education in Atopic Dermatitis: Worldwide Experiences(2013) STALDER, Jean-Francois; BERNIER, Claire; BALL, Alan; RAEVE, Linda De; GIELER, Uwe; DELEURAN, Mette; MARCOUX, Danielle; EICHENFIELD, Lawrence F.; LIO, Peter; LEWIS-JONES, Sue; GELMETTI, Carlo; TAKAOKA, Roberto; CHIAVERINI, Christine; MISERY, Laurent; BARBAROT, SebastienTherapeutic patient education (TPE) has proven effective in increasing treatment adherence and improving quality of life (QoL) for patients with numerous chronic diseases, especially atopic dermatitis (AD). This study was undertaken to identify worldwide TPE experiences in AD treatment. Experts from 23 hospitals, located in 11 countries, responded to a questionnaire on 10 major items. Patients in TPE programs were mainly children and adolescents with moderate to severe AD or markedly affected QoL. Individual and collective approaches were used. Depending on the center, the number of sessions varied from one to six (corresponding to 2 to 12hours of education), and 20 to 200 patients were followed each year. Each center's education team comprised multidisciplinary professionals (e.g., doctors, nurses, psychologists). Evaluations were based on clinical assessment, QoL, a satisfaction index, or some combination of the three. When funding was obtained, it came from regional health authorities (France), insurance companies (Germany), donations (United States), or pharmaceutical firms (Japan, Italy). The role of patient associations was always highlighted, but their involvement in the TPE process varied from one country to another. Despite the nonexhaustive approach, our findings demonstrate the increasing interest in TPE for managing individuals with AD. In spite of the cultural and financial differences between countries, there is a consensus among experts to integrate education into the treatment of eczema.
conferenceObject GLOBAL EPIDEMIOLOGY SURVEY OF PREVALENCE, DISEASE SEVERITY, TREATMENT PATTERNS IN ATOPIC DERMATITIS: RESULTS FOR 2 LATIN AMERICAN COUNTRIES(2021) TAKAOKA, Roberto; SILVERBERG, Jonathan I.; WOLLENBERG, Andreas; EGEBERG, Alexander; LEHRHAUPT, Kerri; JENKINS, Matthew P.; FRAJZYNGIER, Vera; MYERS, Daniela E.; LEON, Dario Ponce de; GUTTMAN-YASSKY, Emma- Atopic dermatitis: A global health perspective(2024) FAYE, Ousmane; FLOHR, Carsten; KABASHIMA, Kenji; MA, Lin; PALLER, Amy S.; RAPELANORO, Fahafahantsoa Rabenja; STEINHOFF, Martin; SU, John C.; TAKAOKA, Roberto; WOLLENBERG, Andreas; YEW, Yik Weng; POSTIGO, Jose A. Ruiz; SCHMID-GRENDELMEIER, Peter; TAIEB, AlainThe International Society of AD (ISAD) organized a roundtable on global aspects of AD at the WCD 2023 in Singapore. According to the Global Burden of Disease (GBD) consortium, at least 171 million individuals were affected with AD in 2019, corresponding to 2.23% of the world population, with age-standardized prevalence and incidence rates that were relatively stable from 1990 to 2019. Based on the panel experience, most AD cases are mild-to-moderate. Without parallel data on disease prevalence and severity, the GBD data are difficult to interpret in many regions. This gap is particularly important in countries with limited medical infrastructure, but indirect evidence suggests a significant burden of AD in low-and-medium resource settings, especially urban areas. The Singapore roundtable was an opportunity to compare experiences in World Bank category 1 (Madagascar and Mali), 3 (Brazil, China) and 4 (Australia, Germany, Qatar, USA, Singapore, Japan) countries. The panel concluded that current AD guidelines are not adapted for low resource settings and a more pragmatic approach, as developed by WHO for skin NTDs, would be advisable for minimal access to moisturizers and topical corticosteroids. The panel also recommended prioritizing prevention studies, regardless of the level of existing resources. For disease long-term control in World Bank category 3 and most category 4 countries, the main problem is not access to drugs for most mild-to-moderate cases, but rather poor compliance due to insufficient time at visits. Collaboration with WHO, patient advocacy groups and industry may promote global change, improve capacity training and fight current inequalities. Finally, optimizing management of AD and its comorbidities needs more action at the primary care level, because reaching specialist care is merely aspirational in most settings. Primary care empowerment with store and forward telemedicine and algorithms based on augmented intelligence is a future goal.