Browsing by Author "Pons-Estel, Bernardo"

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    Factors predictive of high disease activity early in the course of SLE in patients from a Latin-American cohort
    (Elsevier, 2017) Pimentel-Quiroz, Victor; Ugarte-Gil, Manuel; Pons-Estel, Guillermo; Soriano, Enrique; Saurit, Veronica; Sato, Emilia; Lavras Costallat, Lilian; Molina, Jose Fernando; Iglesias-Gamarra, Antonio; Reyes Llerena, Gil; Neira, Oscar; Barile Fabris, Leonor; Silveira, Luis; Segami, Maria Ines; Chacón-Díaz, Rosa; Wojdyla, Daniel; Alarcón, Graciela S.; Pons-Estel, Bernardo
    AIMS: To determine the factors predictive of disease activity early in the course of SLE (baseline visit). METHODS: Patients from GLADEL, a multi-national, multi-ethnic, Latin-American lupus cohort were included. Disease activity was evaluated at baseline with the SLEDAI score. Demographic characteristics (age at diagnosis, gender, ethnicity, marital status, educational level, medical coverage and socioeconomic status) were assessed. Disease duration was defined as the time between the fourth ACR criterion and baseline. Time to criteria accrual was defined as the interval between the first and fourth ACR criterion. Use of glucocorticoids was recorded as the highest dose received before the baseline visit. Antimalarials and immunosuppressive drugs were recorded as use or not use. Univariable and multivariable analysis were performed. Model selection was based on backward elimination. RESULTS: One thousand two hundred sixty-eight patients were included; 1136 (89.6%) of them were female. Mean age at diagnosis was 29.2 (SD: 12.3) years. Five hundred sixty-five (44.6%) were Mestizo, 539 (42.5%) were Caucasians and 164 (12.9%) were African-Latin-Americans. The mean SLEDAI at baseline was 10.9 (SD: 8.4). Longer time between first and fourth ACR criterion, medical coverage, a dose of prednisone between 15 and 60mg/d, and the use of antimalarials were factors protective of disease activity, while Mestizo and African-Latin-American ethnicities were predictive factors. CONCLUSIONS: Mestizo and African-Latin-American ethnicities were predictive whereas antimalarial use, medical coverage, and longer time to criteria accrual were protective of higher disease activity early in the disease course.
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    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; Bonfa, Eloisa; Soriano, Enrique R.; Izcovich, Ariel; Popoff, Federico; Criniti, Juan M.; Vásquez, Gloria; Massardo, Loreto; Duarte, Margarita; Barile-Fabris, Leonor A.; García, Mercedes A.; Amigo, Mary-Carmen; Espada, Graciela; Catoggio, Luis J.; Sato, Emilia Inoue; Levy, Roger A.; Acevedo Vásquez, Eduardo M.; Chacón-Díaz, Rosa; Galarza-Maldonado, Claudio M.; Iglesias Gamarra, Antonio J.; Molina, José Fernando; Neira, Oscar; Silva, Clovis A.; Vargas Peña, Andrea; Gómez-Puerta, José A.; Scolnik, Marina; Pons-Estel, Guillermo J.; Ugolini-Lopes, Michelle R.; Savio, Verónica; Drenkard, Cristina; Alvarellos, Alejandro J.; Ugarte-Gil, Manuel F.; Babini, Alejandra; Cavalcanti, André; Cardoso Linhares, Fernanda Athayde; Haye Salinas, Maria Jezabel; Fuentes-Silva, Yurilis J.; Montandon de Oliveira E Silva, Ana Carolina; Eraso Garnica, Ruth M.; Herrera Uribe, Sebastián; Gómez-Martín, Diana; Robaina Sevrini, Ricardo; Quintana, Rosana M.; Gordon, Sergio; Fragoso-Loyo, Hilda; Rosario, Violeta; Saurit, Verónica; Appenzeller, Simone; Torres Dos Reis Neto, Edgard; Cieza, Jorge
    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.

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