EDUARDO FERREIRA BORBA NETO
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Departamento de Clínica Médica, Faculdade de Medicina - Docente
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
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article Efecto de los antimaláricos sobre los diferentes dominios del índice de daño SLICC en pacientes de la cohorte GLADEL(2018) PONS-ESTEL, Guillermo J.; QUINTANA, Rosana; WOJDYLA, Daniel; ALARCÓN, Graciela S.; SERRANO, Rosa María; UGARTE-GIL, Manuel; PIMENTEL-QUIROZ, Víctor; SORIANO, Enrique R.; CATOGGIO, Luis J.; SCOLNIK, Marina; SACNUN, Mónica; SAURIT, Verónica; CAEIRO, Francisco; ALVARELLOS, Alejandro; SARANO, Judith; GARCÍA, Mercedes; ONETTI, Laura; DRENKARD, Cristina; BERBOTTO, Guillermo; SCHERBARTH, Hugo R.; SATO, Emilia; BONFA, Eloisa; FERREIRA BORBA, Eduardo; COSTALLAT, Lilian; XAVIER, Ricardo; TAVARES BRENOL, Joao C.; DA SILVA, Nilzio A.; CAVALCANTI, Fernando; MASSARDO, Loreto; JACOBELLI, Sergio; NEIRA, Oscar; MOLINA, José F; VÁSQUEZ, Gloria; GÓMEZ-PUERTA, José A.; ALONSO GONZALEZ, Luis; IGLESIAS GAMARRA, Antonio; GUIBERT-TOLEDANO, Marlene; REYES, Gil A.; CARDIEL, Mario H.; PASCUAL-RAMOS, Virginia; GARCÍA DE LA TORRE, Ignacio; BARILE, Leonor; SILVEIRA, Luis H.; AMIGO, Mary-Carmen; SAUZA DEL POZO, María Josefina; ACEVEDO-VÁSQUEZ, Eduardo M.; ALFARO-LOZANO, José; SEGAMI, María Inés; CHACÓN-DÍAZ, Rosa; ABADI, Isaac; ESTEVA SPINETTI, María H; PONS-ESTEL, Bernardo A.Objective: To assess the effects of antimalarials (AM) over the items of the SLICC Damage Index (SDI). Methods: Patients with recent (≤2 years) diagnosis of systemic lupus erythematosus (SLE) from the GLADEL cohort were studied. End-point: increase in items SDI since cohort entry. Independent variables (socio-demographic, clinical, laboratory and treatment) were included. The effect of AM as a time dependent variable on most frequent SDI items (adjusting for potential confounders) was examined with a multivariable Cox regression model. Results: Of the 1466 patients included in this analysis, 1049 (72%) received AM with a median exposure time of 30 months (Q1-Q3: 11-57). Damage occurred in 665 (45%) patients during a median follow-up time of 24 months (Q1-Q3: 8-55). There were 301 integument, 208 renal, 149 neuropsychiatric, 98 musculoskeletal, 88 cardiovascular and 230 others less frequently represented damages. After adjusting for potential confounders at any time during follow-up, a lower risk of renal damage (HR 0.652; 95% CI: 0.472-0.901) and borderline for neuropsychiatric damage (HR 0.701, 95% CI: 0.481-1.024) was found. Conclusion: In the GLADEL cohort, after adjustment for possible confounding factors, AM were independently associated with a reduced risk of renal damage accrual.- Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL)(2020) REATEGUI-SOKOLOVA, Cristina; UGARTE-GIL, Manuel F.; HARVEY, Guillermina B.; WOJDYLA, Daniel; PONS-ESTEL, Guillermo J.; QUINTANA, Rosana; SERRANO-MORALES, Rosa M.; SACNUN, Monica P.; CATOGGIO, Luis J.; SORIANO, Enrique R.; GARCIA, Mercedes A.; SAURIT, Veronica; ALVARELLOS, Alejandro; CAEIRO, Francisco; BERBOTTO, Guillermo A.; I, Emilia Sato; BORBA NETO, Eduardo Ferreira; BONFA, Eloisa; MONTANDON, Ana Carolina de Oliveira e Silva; SILVA, Nilzio A. Da; CAVALCANTI, Fernando; VASQUEZ, Gloria; GUIBERT-TOLEDANO, Marlene; REYES-LLERENA, Gil A.; MASSARDO, Loreto; NEIRA, Oscar J.; CARDIEL, Mario H.; BARILE-FABRIS, Leonor A.; AMIGO, Mary-Carmen; SILVEIRA, Luis H.; PORTELA-HERNANDEZ, Margarita; TORRE, Ignacio Garcia de la; SEGAMI, Maria Ines; CHACON-DIAZ, Rosa; ESTEVA-SPINETTI, Maria H.; ALARCON, Graciela S.; PONS-ESTEL, Bernardo A.Aim A decrease in proteinuria has been considered protective from renal damage in lupus nephritis (LN), but a cut-off point has yet to be established. The aim of this study was to identify the predictors of renal damage in patients with LN and to determine the best cut-off point for a decrease in proteinuria. Methods We included patients with LN defined clinically or histologically. Possible predictors of renal damage at the time of LN diagnosis were examined: proteinuria, low complement, anti-double-stranded DNA antibodies, red cell casts, creatinine level, hypertension, renal activity (assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)), prednisone dose, immunosuppressive drugs and antimalarial use. Sociodemographic variables were included at baseline. Proteinuria was assessed at baseline and at 12 months, to determine if early response (proteinuria <0.8 g/day within 12 months since LN diagnosis) is protective of renal damage occurrence. Renal damage was defined as an increase of one or more points in the renal domain of The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). Cox regression models using a backward selection method were performed. Results Five hundred and two patients with systemic lupus erythematosus patients were included; 120 patients (23.9%) accrued renal damage during their follow-up. Early response to treatment (HR=0.58), antimalarial use (HR=0.54) and a high SES (HR=0.25) were protective of renal damage occurrence, whereas male gender (HR=1.83), hypertension (HR=1.86) and the renal component of the SLEDAI (HR=2.02) were risk factors for its occurrence. Conclusions Early response, antimalarial use and high SES were protective of renal damage, while male gender, hypertension and higher renal activity were risk factors for its occurrence in patients with LN.
- First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR)(2018) PONS-ESTEL, Bernardo A.; BONFA, Eloisa; SORIANO, Enrique R.; CARDIEL, Mario H.; IZCOVICH, Ariel; POPOFF, Federico; CRINITI, Juan M.; VASQUEZ, Gloria; MASSARDO, Loreto; DUARTE, Margarita; BARILE-FABRIS, Leonor A.; GARCIA, Mercedes A.; AMIGO, Mary-Carmen; ESPADA, Graciela; CATOGGIO, Luis J.; SATO, Emilia Inoue; LEVY, Roger A.; VASQUEZ, Eduardo M. Acevedo; CHACON-DIAZ, Rosa; GALARZA-MALDONADO, Claudio M.; GAMARRA, Antonio J. Iglesias; MOLINA, Jose Fernando; NEIRA, Oscar; SILVA, Clovis A.; PENA, Andrea Vargas; GOMEZ-PUERTA, Jose A.; SCOLNIK, Marina; PONS-ESTEL, Guillermo J.; UGOLINI-LOPES, Michelle R.; SAVIO, Veronica; DRENKARD, Cristina; ALVARELLOS, Alejandro J.; UGARTE-GIL, Manuel F.; BABINI, Alejandra; CAVALCANTI, Andre; LINHARES, Fernanda Athayde Cardoso; SALINAS, Maria Jezabel Haye; FUENTES-SILVA, Yurilis J.; SILVA, Ana Carolina Montandon de Oliveira e; GARNICA, Ruth M. Eraso; URIBE, Sebastian Herrera; GOMEZ-MARTIN, Diana; SEVRINI, Ricardo Robaina; QUINTANA, Rosana M.; GORDON, Sergio; FRAGOSO-LOYO, Hilda; ROSARIO, Violeta; SAURIT, Veronica; APPENZELLER, Simone; REIS NETO, Edgard Torres dos; CIEZA, Jorge; NARANJO, Luis A. Gonzalez; BELLO, Yelitza C. Gonzalez; COLLADO, Maria Victoria; SARANO, Judith; RETAMOZO, Soledad; SATTLER, Maria E.; GAMBOA-CARDENAS, Rocio V.; CAIROLI, Ernesto; CONTI, Silvana M.; AMEZCUA-GUERRA, Luis M.; SILVEIRA, Luis H.; BORBA, Eduardo F.; PERA, Mariana A.; MOREYRA, Paula B. Alba; ARTURI, Valeria; BERBOTTO, Guillermo A.; GERLING, Cristian; GOBBI, Carla A.; GERVASONI, Viviana L.; SCHERBARTH, Hugo R.; BRENOL, Joao C. Tavares; CAVALCANTI, Fernando; COSTALLAT, Lilian T. Lavras; SILVA, Nilzio A. Da; MONTICIELO, Odirlei A.; SEGURO, Luciana Parente Costa; XAVIER, Ricardo M.; LLANOS, Carolina; GUARDADO, Ruben A. Montufar; TORRE, Ignacio Garcia de la; PINEDA, Carlos; HERNANDEZ, Margarita Portela; DANZA, Alvaro; GUIBERT-TOLEDANO, Marlene; REYES, Gil Llerena; COLMAN, Maria Isabel Acosta; AQUINO, Alicia M.; MORA-TRUJILLO, Claudia S.; MUNOZ-LOUIS, Roberto; VALLADARES, Ignacio Garcia; OROZCO, Maria Celeste; BURGOS, Paula I.; BETANCUR, Graciela V.; ALARCON, Graciela S.Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.