ROBERTO TAKAOKA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
19 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 19
- 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.
- Methotrexate for atopic dermatitis in adults: a prospective study from a reference center in Brazil(2021) SAMORANO, Luciana Paula; TAKAOKA, Roberto; ZANIBONI, Mariana Colombini; AOKI, Valeria
conferenceObject A 25-year overview of the atopic dermatitis outpatient clinic at the University of Sao Paulo Medical School, Brazil(2014) ZANIBONI, M. C.; ORFALI, R. L.; TAKAOKA, R.; ISHIZAKI, A. S.; AOKI, V.- 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.
- Education of Patients with Atopic Dermatitis and Their Caregivers(2016) TAKAOKA, Roberto; AOKI, ValeriaAtopic dermatitis (AD) is the most prevalent dermatological disease in the pediatric population. It is a chronic, pruritic, and inflammatory skin disorder, with a complex etiology involving genetic predisposition, skin barrier defects, and immune dysfunction. AD can be a challenge for patients, physicians, and caregivers and has a clear impact in patients' quality of life (QoL). Educational programs for patients with AD and their caregivers are effective in improving adherence, QoL, and clinical outcomes. Different models of educational programs exist and their structures depend on cultural, social, and economic factors. To improve existing programs, the educational team should go beyond the disease and have a broader view of the many aspects involved in the pathological process. These include psychological, environmental, social, financial, and cultural aspects. Patients and their caregivers should have a more realistic expectation about the treatment. Innovative methods and approaches like design thinking can create new and effective solutions for patients with AD and their caregivers.
conferenceObject Atopic dermatitis in adults: Augmented circulating IgG4 and IgE antibodies against Staphylococcus aureus enterotoxin B(2013) ORFALI, R. L.; SATO, M. N.; SANTOS, V. G. Dos; TITZ, T. O.; DUARTE, A. S.; TAKAOKA, R.; AOKI, V.The aim of this study was to evaluate the profile of anti-Staphylococcus aureus enterotoxin B (SEB) antibody (Ab) response in adults with AD. We selected 38 patients diagnosed as AD (Hanifin & Rajka's criteria), aged between 18 and 65, and 26 healthy controls (HC), aged between 20 and 47 years. Severity of the disease was established according to EASI (Eczema Area and Severity Index) and patients were graded as mild (28%), moderate (58%) and severe (14%). Sera were assessed for IgG subclasses, IgA, IgM and IgE against SEB by ELISA. The humoral response in AD patients to SEB showed elevated circulating IgE and IgG4 levels (p < 0.05 and p δ 0.001, respectively), and decreased IgA and IgM levels (p < 0.05). Severity of atopic dermatitis was related with low IgG1 and IgG3 levels (p < 0.05), and high IgE antibody response (p < 0.05) to SEB. Interestingly, absence of IgE and IgG1 response to SEB was seen in some AD patients (26.3% and 18.4% respectively). In AD, the immunoglobulin-related subtype Th2 lymphocytes, such as IgE and IgG4, appear to be relevant in the response to superantigens. These results emphasize an altered pattern of Ab response to SEB in AD, which is impaired according the disease severity.bookPart Doenças zooparasitárias(2019) BESSA, Vanessa Rolim; TAKAOKA, Roberto- 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.