EDUARDO FERREIRA BORBA NETO
Projetos de Pesquisa
Unidades Organizacionais
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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- Measurement properties of selected patient-reported outcome measures for use in randomised controlled trials in patients with systemic lupus erythematosus: a systematic review(2020) STRAND, Vibeke; SIMON, Lee S.; MEARA, Alexa Simon; TOUMA, Zahi; BORBA NETO, Eduardo FerreiraObjective The heterogeneous multisystem manifestations of SLE include fatigue, pain, depression, sleep disturbance and cognitive dysfunction, and underscore the importance of a multidimensional approach when assessing health-related quality of life. The US Food and Drug Administration has emphasised the importance of patient-reported outcomes (PROs) for approval of new medications and Outcome Measures in Rheumatology has mandated demonstration of appropriate measurement properties of selected PRO instruments. Methods Published information regarding psychometric properties of the Medical Outcomes Survey Short Form 36 (SF-36), Lupus Quality of Life Questionnaire (LupusQoL) and Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F), and their suitability as end points in randomised controlled trials (RCTs) and longitudinal observational studies (LOS) were assessed. A search of English-language literature using MEDLINE and EMBASE identified studies related to development and validation of these instruments. Evidence addressed content validity, reliability (internal consistency and test-retest reliability), construct validity (convergent and divergent) and longitudinal responsiveness, including thresholds of meaning and discrimination. Results All instruments demonstrated strong internal consistency, reliability and appropriate face/content validity, indicating items within each instrument that measure the intended concept. SF-36 and LupusQoL demonstrated test-retest reliability; although not published with FACIT-F in SLE supported by evidence from other rheumatic diseases. All instruments demonstrated convergent validity with other comparable PROs and responsivity to treatment. Conclusion The measurement properties of PRO instruments with published data from RCTs including: SF-36, LupusQoL and FACIT-F indicate their value as secondary end points to support labelling claims in RCTs and LOS evaluating the efficacy of SLE treatments.
- Chronic low back pain and sick-leave: a functional magnetic resonance study(2020) FEITOSA, Aloma A.; AMARO JUNIOR, Edson; SANCHES, Liana Guerra; BORBA, Eduardo Ferreira; JORGE, Liliana Lourenco; HALPERN, Ari Stiel RaduBackground Chronic low back pain (CLBP) represents a problem in the occupational environment, often associated with disability, sick-leave demands, loss of productivity, anxiety, depression and high socioeconomic cost. The emergence of functional neuroimaging allowed new insights into brain structure and physiology in normality and chronic pain. While occupational related aspects are recognized as important risk factors for chronicity there have not been thus far evaluated by fMRI experiments. The overall objective of this study is to compare the neuronal correlates between groups of individuals CLBP with or without sick-leave demands. Methods A total of 74 individuals were divided into three groups: chronic low back pain with sick-leave demands [CLBP_L]; chronic low back pain without sick-leave demands [CLBP_NL]; individuals without pain or sick-leave demands [Control]. Functional magnetic resonance imaging was used to assess brain function during moderate acute pain stimulation task (thumb controlled pressure). Results After acute painful stimulation, a higher brain response was found in the anterior cingulate and superior and medium frontal gyrus was observed in CLBP_NL vs. CLBP_L (p < 0,001) and increased brain response in the frontal pole and paracingulate region in control vs. CLBP_L (p < 0.001) during acute pain stimulation. Conclusion The modulation of acute pain participates in the mechanism propagating chronic pain perception. The lower activation in the superior frontal gyrus observed in the CLBP_L group compared to CLBP_NL, reinforces the idea of an already existing activation in this area.
- Clinical features, damage accrual, and survival in patients with familial systemic lupus erythematosus: data from a multi-ethnic, multinational Latin American lupus cohort(2020) QUINTANA, Rosana; PONS-ESTEL, Guillermo J.; ROBERTS, Karen; SACNUN, Monica; SERRANO, Rosa; NIETO, Romina; CONTI, Silvana; GERVASONI, Viviana; CATOGGIO, Luis J.; SORIANO, Enrique R.; SCOLNIK, Marina; GARCIA, Mercedes A.; ALVARELLOS, Alejandro; SAURIT, Veronica; BERBOTTO, Guillermo A.; I, Emilia Sato; COSTALLAT, Lilian T. Lavras; BORBA NETO, Eduardo Ferreira; BONFA, Eloisa; XAVIER, Ricardo M.; MONTANDON, Ana Carolina de Oliveira e Silva; MOLINA-RESTREPO, Jose Fernando; IGLESIAS-GAMARRA, Antonio; GUIBERT-TOLEDANO, Marlene; REYES-LLERENA, Gil Alberto; MASSARDO, Loreto; NEIRA, Oscar J.; CARDIEL, Mario H.; BARILE-FABRIS, Leonor A.; AMIGO, Mary-Carmen; SILVEIRA, Luis H.; TORRE, Ignacio Garcia De La; ACEVEDO-VASQUEZ, Eduardo M.; UGARTE-GIL, Manuel F.; ALFARO-LOZANO, Jose Luis; SEGAMI, Maria Ines; CHACON-DIAZ, Rosa; ESTEVA-SPINETTI, Maria H.; GOMEZ-PUERTA, Jose A.; ALARCON, Graciela S.; PONS-ESTEL, Bernardo A.Objectives This study aimed to compare the clinical features, damage accrual, and survival of patients with familial and sporadic systemic lupus erythematosus (SLE). Methods A multi-ethnic, multinational Latin American SLE cohort was studied. Familial lupus was defined as patients with a first-degree SLE relative; these relatives were interviewed in person or by telephone. Clinical variables, disease activity, damage, and mortality were compared. Odds ratios (OR) and 95% confidence intervals (CI) were estimated. Hazard ratios (HR) were calculated using Cox proportional hazard adjusted for potential confounders for time to damage and mortality. Results A total of 66 (5.6%) patients had familial lupus, and 1110 (94.4%) had sporadic lupus. Both groups were predominantly female, of comparable age, and of similar ethnic distribution. Discoid lupus (OR = 1.97; 95% CI 1.08-3.60) and neurologic disorder (OR = 1.65; 95% CI 1.00-2.73) were significantly associated with familial SLE; pericarditis was negatively associated (OR = 0.35; 95% CI 0.14-0.87). The SLE Disease Activity Index and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) were similar in both groups, although the neuropsychiatric (45.4% vs. 33.5%;p = 0.04) and musculoskeletal (6.1% vs. 1.9%;p = 0.02) domains of the SDI were more frequent in familial lupus. They were not retained in the Cox models (by domains). Familial lupus was not significantly associated with damage accrual (HR = 0.69; 95% CI 0.30-1.55) or mortality (HR = 1.23; 95% CI 0.26-4.81). Conclusion Familial SLE is not characterized by a more severe form of disease than sporadic lupus. We also observed that familial SLE has a higher frequency of discoid lupus and neurologic manifestations and a lower frequency of pericarditis.
- 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.
- Understanding the dynamics of hydroxychloroquine blood levels in lupus nephritis(2020) PEDROSA, Tatiana N.; PASOTO, Sandra G.; AIKAWA, Nadia E.; YUKI, Emily F. N.; BORBA, Eduardo F.; FERREIRA FILHO, Julio C. R.; CARRICONDO, Pedro C.; ZANETTI, Caio B.; CONDE, Paola G.; DUARTE, Nilo J. C.; FONTOURA, Nicole; ROMANO, Paschoalina; CARVALHO, Valdemir M.; SILVA, Clovis A.; BONFA, EloisaObjectives It is unknown if hydroxychloroquine blood level dynamics impact flare rates in lupus nephritis patients. We prospectively evaluated hydroxychloroquine levels to determine which blood-based patterns are more associated with disease activity. Methods In total, 82 lupus nephritis patients under a prescribed hydroxychloroquine dose of 4-5.5 mg/kg actual body weight (maximum 400 mg/day) for >= 3 months were evaluated at baseline and 7 months. Hydroxychloroquine blood levels were determined by liquid chromatography-tandem mass spectrometry. Flare was defined as increase >= 3 in the Systemic Lupus Erythematosus Disease Activity Index 2000 score and/or a change or increase in therapy. Results Overall, 9/82(11%) patients had flares during follow-up and had lower baseline hydroxychloroquine blood levels than those without flares (220.4 (53.5-1471.1) vs. 1006.3 (53.5-2137.8) ng/ml, p = 0.013). The hydroxychloroquine blood level cut-off that best predicted flares was 613.5 ng/ml (odds ratio = 8.67, 95% confidence interval: 1.66-45.18, p = 0.006). For 77 (94%) patients, the 7-month hydroxychloroquine level dynamics was evaluated and revealed: 59/77 (77%) had a persistent pattern of adequate (41/77(53%)) or fluctuating (18/77 (23%)) levels, with a low and comparable risk of flares (2/41 (5%) vs. 1/18 (5%), p = 1.000). The remaining group had persistent low levels (18/77 (23%)) and their flare frequency was significantly higher than the adequate group (5/18 (28%) vs. 2/41 (5%), p = 0.023). The frequencies of adequate/inadequate hydroxychloroquine blood levels in patients were comparable at baseline and 7 months (McNemar's test, p = 0.480). Conclusion We provide novel evidence that hydroxychloroquine blood-level patterns (persistently low, adequate, or intermittent) have distinct impacts on flare rates in lupus nephritis patients. These findings reinforce the need of routine hydroxychloroquine measurements to maintain the appropriate blood levels.
conferenceObject Impact of Remission and Low Disease Activity Status on Hospitalizations Among SLE Patients from the GLADEL Latin American Cohort(2020) PONS-ESTEL, Guillermo; UGARTE-GIL, Manuel; HARVEY, Guillermina; WOJDYLA, Daniel; QUINTANA, Rosana; SERRANO-MORALES, Rosa; GOMEZ-PUERTA, Jose; GARCIA, Mercedes; CATOGGIO, Luis; SAURIT, Veronica; DRENKARD, Cristina; SILVA, Nilzio Antonio Da; CAVALCANTI, Fernando; BORBA, Eduardo; SATO, Emilia; NEIRA, Oscar; MASSARDO, Loreto; VASQUEZ, Gloria; GONZALEZ, Luis Alonso; TOLEDAN, Marlene Guibert; SILVEIRA, Luis; TORRE, Ignacio Garcia De La; POZO, Maria Josefina Sauza del; CHACON, Rosa; CARDIEL, Mario; ALARCON, Graciela; PONS-ESTEL, BernardoconferenceObject Avoiding Misclassification of Primary Antiphospholipid Syndrome as Systemic Lupus Erythematosus: What Are the Best-performing SLE Classification Criteria?(2020) SIGNORELLI, Flavio; BALBI, Gustavo; BONFA, Eloisa; BORBA, Eduardo; ANDRADE, Danieli