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Harskamp R, Lopes R, Li Z, Wojdyla D, Goodman S, Aronson R, Windecker S, Mehran R, Granger C, Alexander J. Safety and efficacy of antithrombotic therapy according to stroke and bleeding risk in patients with atrial fibrillation and acute coronary syndrome or PCI: insights from AUGUSTUS. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The AUGUSTUS trial showed that patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) and/or PCI treated with a P2Y12 inhibitor and apixaban resulted in less bleeding and comparable ischemic events compared with regimens that included a vitamin K antagonist (VKA), aspirin, or both. We assessed the effect of apixaban versus VKA and aspirin versus placebo according to patients' baseline risk of stroke and bleeding.
Methods
AUGUSTUS randomized 4614 patients in a two-by-two factorial design to open label apixaban or VKA and blinded aspirin or placebo. The primary endpoint was major or clinically relevant nonmajor (CRNM) bleeding over 6 months of follow-up. The effects were assessed stratified by baseline CHA2DS2-VASc and HAS-BLED score using Cox proportional hazards models.
Results
4386 patients were included for this analysis. The median age was 71 (64–77) years, 29.4% were female, 81.7% had a CHA2DS2-VASc score≥3, and 66.8% a HAS-BLED score≥3. As shown in the table, rates of bleeding were lower with apixaban (vs VKA) irrespective of baseline bleeding risk (p-value interaction: 0.23). Aspirin (vs placebo) was associated with increased bleeding irrespective of baseline risk (p-value interaction: 0.88). Apixaban use was associated with a lower risk of death or hospitalization without a significant interaction with stroke risk (p-value of interaction=0.53). No differences were found for ischemic outcomes.
Conclusion
An antithrombotic regimen including a P2Y12 inhibitor and apixaban is associated with less bleeding and hospitalization compared to a regimen with VKA, aspirin, or both with results consistent across CHA2DS2-VASc, and HAS-BLED scores. Our findings support the use of apixaban and a P2Y12 inhibitor without aspirin during the first 6 months for most patients with AF and ACS and/or PCI, regardless of stroke and bleeding risk.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The Augustus trial was sponsored by Bristol-Myers Squibb and Pfizer, Inc
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Affiliation(s)
- R Harskamp
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - R.D Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, United States of America
| | - Z Li
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, United States of America
| | - D Wojdyla
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, United States of America
| | - S.G Goodman
- Canadian Vigour Center, University of Alberta and St Michael's Hospital, University of Toronto, Edmonton, Canada
| | - R Aronson
- Bristol-Myers Squibb, Lawrenceville, United States of America
| | - S Windecker
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - R Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, and Cardiovascular Research Foundation, New York, United States of America
| | - C.B Granger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, United States of America
| | - J.H Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, United States of America
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Zeitouni M, Giczewska A, Lopes RD, Wojdyla D, Christersson C, De Caterina R, Steg PG, Granger CB, Wallentin L, Alexander JH. P4752Apixaban 2.5 mg twice daily is effective and safe for patients with atrial fibrillation and combinations of advanced age, low body weight, and elevated creatinine: insights from ARISTOTLE. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In ARISTOTLE, patients with atrial fibrillation and ≥2 dose-reduction criteria [age ≥80 years, weight ≤60 kg, and creatinine ≥1.5 mg/dL (133 μmol/L)] were randomized to apixaban 2.5 mg twice daily (b.i.d) or warfarin.
Purpose
To determine whether the apixaban dose adjustment in ARISTOTLE resulted in similar efficacy and safety compared to warfarin.
Methods
The effects of apixaban 2.5 mg b.i.d versus warfarin on stroke or systemic embolism, major bleeding and death in ARISTOTLE patients with ≥2 dose-reduction criteria were compared with the effects of apixaban 5 mg b.i.d in patients with 0 or 1 dose-reduction criterion.
Results
Of 751 (4.1%) patients with ≥2 dose-reduction criteria, 386 were assigned to apixaban 2.5 mg b.i.d and 365 to warfarin. Compared to patients with 0 or 1 dose reduction criteria (n=17,322), these patients had a higher risks of stroke/systemic embolism (HR =1.78; 95% CI [1.24–2.57]), major bleeding (HR =1.73; 95% CI [1.28–2.32]) and death (HR=3.21; 95% CI [2.69–3.83]), irrespective of whether they were assigned to apixaban or warfarin. The benefits of apixaban 2.5 mg b.i.d compared with warfarin on stroke or systemic embolism, major bleeding, and death in patients with ≥2 dose-reduction criteria were consistent with that of apixaban 5 mg b.i.d in patients with either 0 or 1 dose-reduction criteria (Figure).
Conclusions
While they are at higher overall risk, patients with appropriate dose reduction criteria have consistent benefits with apixaban 2.5 mg b.i.d. over warfarin. Additional analyses investigating the relationship between apixaban dose and both apixaban plasma concentrations and levels of thrombosis biomarkers are underway.
Acknowledgement/Funding
Bristol-Myers Squibb and Pfizer, Inc.
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Affiliation(s)
- M Zeitouni
- Duke Clinical Research Institute, Durham, United States of America
| | - A Giczewska
- Duke Clinical Research Institute, Durham, United States of America
| | - R D Lopes
- Duke Clinical Research Institute, Durham, United States of America
| | - D Wojdyla
- Duke Clinical Research Institute, Durham, United States of America
| | - C Christersson
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - R De Caterina
- University of Pisa, Division of Cardiovascular Medicine, Cardio-Thoracic and Vascular Department, Pisa, Italy
| | - P G Steg
- Hospital Bichat-Claude Bernard, Cardiology Department, AP-HP, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - C B Granger
- Duke Clinical Research Institute, Durham, United States of America
| | - L Wallentin
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - J H Alexander
- Duke Clinical Research Institute, Durham, United States of America
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Pimentel-Quiroz VR, Ugarte-Gil MF, Harvey GB, Wojdyla D, Pons-Estel GJ, Quintana R, Esposto A, García MA, Catoggio LJ, Cardiel MH, Barile LA, Amigo MC, Sato EI, Bonfa E, Borba E, Lavras Costallat LT, Neira OJ, Massardo L, Guibert-Toledano M, Chacón-Díaz R, Alarcón GS, Pons-Estel BA. Factors predictive of serious infections over time in systemic lupus erythematosus patients: data from a multi-ethnic, multi-national, Latin American lupus cohort. Lupus 2019; 28:1101-1110. [DOI: 10.1177/0961203319860579] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Aim The aim of this study was to identify factors predictive of serious infections over time in patients with systemic lupus erythematosus (SLE). Methods A multi-ethnic, multi-national Latin American SLE cohort was studied. Serious infection was defined as one that required hospitalization, occurred during a hospitalization or led to death. Potential predictors included were sociodemographic factors, clinical manifestations (per organ involved, lymphopenia and leukopenia, independently) and previous infections at baseline. Disease activity (SLEDAI), damage (SLICC/ACR Damage Index), non-serious infections, glucocorticoids, antimalarials (users and non-users), and immunosuppressive drugs use; the last six variables were examined as time-dependent covariates. Cox regression models were used to evaluate the predictors of serious infections using a backward elimination procedure. Univariable and multivariable analyses were performed. Results Of the 1243 patients included, 1116 (89.8%) were female. The median (interquartile range) age at diagnosis and follow-up time were 27 (20–37) years and 47.8 (17.9–68.6) months, respectively. The incidence rate of serious infections was 3.8 cases per 100 person-years. Antimalarial use (hazard ratio: 0.69; 95% confidence interval (CI): 0.48–0.99; p = 0.0440) was protective, while doses of prednisone >15 and ≤60 mg/day (hazard ratio: 4.18; 95 %CI: 1.69–10.31; p = 0.0019) and >60 mg/day (hazard ratio: 4.71; 95% CI: 1.35–16.49; p = 0.0153), use of methylprednisolone pulses (hazard ratio: 1.53; 95% CI: 1.10–2.13; p = 0.0124), increase in disease activity (hazard ratio: 1.03; 95% CI: 1.01–1.04; p = 0.0016) and damage accrual (hazard ratio: 1.22; 95% CI: 1.11–1.34; p < 0.0001) were predictive factors of serious infections. Conclusions Over time, prednisone doses higher than 15 mg/day, use of methylprednisolone pulses, increase in disease activity and damage accrual were predictive of infections, whereas antimalarial use was protective against them in SLE patients.
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Affiliation(s)
- V R Pimentel-Quiroz
- Department of Rheumatology, Hospital Nacional ‘Guillermo Almenara Irigoyen’ Essalud, Lima, Peru
| | - M F Ugarte-Gil
- Department of Rheumatology, Hospital Nacional ‘Guillermo Almenara Irigoyen’ Essalud, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | - GB Harvey
- Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | - D Wojdyla
- GLADEL consultant, Rosario, Argentina
| | - G J Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - R Quintana
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - A Esposto
- Servicio de Infectología, Hospital Interzonal General de Agudos ‘General San Martín’, La Plata, Argentina
| | - M A García
- Servicio de Infectología, Hospital Interzonal General de Agudos ‘General San Martín’, La Plata, Argentina
| | - L J Catoggio
- Servicio de Reumatolgía, Hospital Italiano and Fundación ‘Dr. Pedro M. Catoggio para el Progreso de la Reumatología’, Buenos Aires, Argentina
| | - M H Cardiel
- Centro de Investigación Clínica de Morelia, Morelia, Michoacán, Mexico
| | - L A Barile
- Servicio de Reumatología, Hospital Ángeles del Pedregal, Ciudad de México, Mexico
| | - M -C Amigo
- Centro Médico ABC, Ciudad de México, Mexico
| | - E I Sato
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - E Bonfa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - L T Lavras Costallat
- Departamento de Clínica Médica, Faculdade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil
| | - O J Neira
- Sección de Reumatología, Hospital del Salvador, Universidad de Chile. Unidad de Reumatología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - L Massardo
- Centro de Biología Celular y Biomedicina, Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile
| | | | - R Chacón-Díaz
- Servicio de Reumatología, Policlínica Méndez Gimón, Caracas, Venezuela
| | - G S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - B A Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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Fudim M, Alexander J, Wojdyla D, Ezekowitz J, Hanna M, Atar D, Hijazi Z, Bahit M, Lopez-Sendon J, Wallentin L, Granger C, Hohnloser S, Lopes R. THE EFFICACY AND SAFETY OF APIXABAN VERSUS WARFARIN ARE PRESERVED IN PATIENTS WITH ATRIAL FIBRILLATION AND EXTREME BODY WEIGHT: INSIGHTS FROM THE ARISTOTLE STUDY. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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5
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Ugarte-Gil MF, Wojdyla D, Pastor-Asurza CA, Gamboa-Cárdenas RV, Acevedo-Vásquez EM, Catoggio LJ, García MA, Bonfá E, Sato EI, Massardo L, Pascual-Ramos V, Barile LA, Reyes-Llerena G, Iglesias-Gamarra A, Molina-Restrepo JF, Chacón-Díaz R, Alarcón GS, Pons-Estel BA. Predictive factors of flares in systemic lupus erythematosus patients: data from a multiethnic Latin American cohort. Lupus 2017; 27:536-544. [PMID: 28857715 DOI: 10.1177/0961203317728810] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose The purpose of this paper is to determine the factors predictive of flares in systemic lupus erythematosus (SLE) patients. Methods A case-control study nested within the Grupo Latino Americano De Estudio de Lupus (GLADEL) cohort was conducted. Flare was defined as an increase ≥4 points in the SLEDAI. Cases were defined as patients with at least one flare. Controls were selected by matching cases by length of follow-up. Demographic and clinical manifestations were systematically recorded by a common protocol. Glucocorticoid use was recorded as average daily dose of prednisone and antimalarial use as percentage of time on antimalarial and categorized as never (0%), rarely (>0-25%), occasionally (>25%-50%), commonly (˃50%-75%) and frequently (˃75%). Immunosuppressive drugs were recorded as used or not used. The association between demographic, clinical manifestations, therapy and flares was examined using univariable and multivariable conditional logistic regression models. Results A total of 465 cases and controls were included. Mean age at diagnosis among cases and controls was 27.5 vs 29.9 years, p = 0.003; gender and ethnic distributions were comparable among both groups and so was the baseline SLEDAI. Independent factors protective of flares identified by multivariable analysis were older age at diagnosis (OR = 0.929 per every five years, 95% CI 0.869-0.975; p = 0.004) and antimalarial use (frequently vs never, OR = 0.722, 95% CI 0.522-0.998; p = 0.049) whereas azathioprine use (OR = 1.820, 95% CI 1.309-2.531; p < 0.001) and SLEDAI post-baseline were predictive of them (OR = 1.034, 95% CI 1.005-1.064; p = 0.022). Conclusions In this large, longitudinal Latin American cohort, older age at diagnosis and more frequent antimalarial use were protective whereas azathioprine use and higher disease activity were predictive of flares.
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Affiliation(s)
- M F Ugarte-Gil
- 1 Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,2 Universidad Científica del Sur, Lima, Perú
| | - D Wojdyla
- 3 Universidad Nacional de Rosario, Rosario, Argentina
| | - C A Pastor-Asurza
- 1 Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,4 Universidad Nacional Mayor de San Marcos, Lima, Perú
| | | | - E M Acevedo-Vásquez
- 1 Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,4 Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - L J Catoggio
- 5 Sección de Reumatología, Servicio de Clínica Médica, Hospital Italiano, Instituto Universitario Escuela de Medicina Hospital Italiano and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - M A García
- 6 Hospital Interzonal General de Agudos "General San Martín," La Plata, Argentina
| | - E Bonfá
- 7 Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - E I Sato
- 8 Disciplina de Reumatología, Escola Paulista de Medicina, Universidade Federal da São Paulo-UNIFESP, São Paulo, Brazil
| | - L Massardo
- 9 Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - V Pascual-Ramos
- 10 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán," Ciudad de Mexico, Mexico
| | - L A Barile
- 11 Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico
| | - G Reyes-Llerena
- 12 Centro de Investigaciones Médico Quirúrgicas-CIMEQ, Habana, Cuba
| | | | | | - R Chacón-Díaz
- 15 Servicio de Reumatología, Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela
| | - G S Alarcón
- 16 Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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Haye Salinas MJ, Caeiro F, Saurit V, Alvarellos A, Wojdyla D, Scherbarth HR, de O e Silva AC, Tavares Brenol JC, Lavras Costallat LT, Neira OJ, Iglesias Gamarra A, Vásquez G, Reyes Llerena GA, Barile-Fabris LA, Silveira LH, Sauza del Pozo MJ, Acevedo Vásquez EM, Alfaro Lozano JL, Esteva Spinetti MH, Alarcón GS, Pons-Estel BA. Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort (GLADEL). Lupus 2017; 26:1368-1377. [DOI: 10.1177/0961203317699284] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The objectives of this study were to examine the demographic and clinical features associated with the occurrence of pleuropulmonary manifestations, the predictive factors of their occurrence and their impact on mortality in systemic lupus erythematosus (SLE) patients. Materials and methods The association of pleuropulmonary manifestations with demographic and clinical features, the predictive factors of their occurrence and their impact on mortality were examined in GLADEL patients by appropriate univariable and multivariable analyses. Results At least one pleuropulmonary manifestation occurred in 421 of the 1480 SLE patients (28.4%), pleurisy being the most frequent (24.0%). Age at SLE onset ≥30 years (OR 1.42; 95% CI 1.10–1.83), the presence of lower respiratory tract infection (OR 3.19; 95% CI 2.05–4.96), non-ischemic heart disease (OR 3.17; 95% CI 2.41–4.18), ischemic heart disease (OR 3.39; 95% CI 2.08–5.54), systemic (OR 2.00; 95% CI 1.37–2.91), ocular (OR 1.58; 95% CI 1.16–2.14) and renal manifestations (OR 1.44; 95% CI 1.09–1.83) were associated with pleuropulmonary manifestations, whereas cutaneous manifestations were negatively associated (OR 0.47; 95% CI 0.29–0.76). Non-ischemic heart disease (HR 2.24; 95% CI 1.63–3.09), SDI scores ≥1 (OR 1.54; 95% CI 1.10–2.17) and anti-La antibody positivity (OR 2.51; 95% CI 1.39–4.57) independently predicted their subsequent occurrence. Cutaneous manifestations were protective of the subsequent occurrence of pleuropulmonary manifestations (HR 0.62; 95% CI 0.43–0.90). Pleuropulmonary manifestations independently contributed a decreased survival (HR: 2.79 95% CI 1.80–4.31). Conclusion Pleuropulmonary manifestations are frequent in SLE, particularly pleuritis. Older age, respiratory tract infection, cardiac, systemic and renal involvement were associated with them, whereas cutaneous manifestations were negatively associated. Cardiac compromise, SDI scores ≥1 and anti-La positivity at disease onset were predictive of their subsequent occurrence, whereas cutaneous manifestations were protective. They independently contributed to a decreased survival in these patients.
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Affiliation(s)
- M J Haye Salinas
- Servicio de Reumatología, Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | - F Caeiro
- Servicio de Reumatología, Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | - V Saurit
- Servicio de Reumatología, Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | - A Alvarellos
- Servicio de Reumatología, Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | - D Wojdyla
- Department of Biostatistics, GLADEL, Rosario, Argentina
| | - H R Scherbarth
- Servicio de Reumatología, Hospital Interzonal General de Agudos “Dr. Oscar Alende” Mar del Plata, Argentina
| | - A C de O e Silva
- Serviço da Reumatología, Facultad de de Medicina, Universida de Federal de Goias, Goiania, Brazil
| | - J C Tavares Brenol
- Serviço de Reumatología, Hospital da Clinicas da Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - L T Lavras Costallat
- Divisao de Reumatología, Faculdade de Ciencias Medicas, Universidade Estadual da Campinas, Campinas, Brazil
| | - O J Neira
- Sección Reumatología, Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - A Iglesias Gamarra
- Servicio de Reumatología, Hospital San Juan de Dios, Facultad de Medicina, Universidad Nacional, Bogotá, Colombia
| | - G Vásquez
- Servicio de Reumatología, Universidad de Antioquia, Hospital Universitario, Fundación San Vicente, Medellin, Colombia
| | - G A Reyes Llerena
- Servicio de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba
| | - L A Barile-Fabris
- Departamento de Reumatologia, Hospital de Especialidades “Bernardo Sepúlveda”, Centro Médico Nacional Siglo XXI, Instituto Mexicano de Seguro Social, México D.F. México
| | - L H Silveira
- Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, México D.F. México
| | - M J Sauza del Pozo
- Servicio de Reumatología, Instituto Mexicano de Seguro Social, Hospital de Especialidades N° 25, Monterrey, N.L., México
| | - E M Acevedo Vásquez
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, ESSALUD, Lima, Perú
| | - J L Alfaro Lozano
- Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, ESSALUD, Lima, Perú
| | - M H Esteva Spinetti
- Unidad de Reumatología, Hospital Central de San Cristobal, San Cristobal, Venezuela
| | - G S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - B A Pons-Estel
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
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7
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Pons-Estel GJ, Aspey LD, Bao G, Pons-Estel BA, Wojdyla D, Saurit V, Alvarellos A, Caeiro F, Haye Salinas MJ, Sato EI, Soriano ER, Costallat LTL, Neira O, Iglesias-Gamarra A, Reyes-Llerena G, Cardiel MH, Acevedo-Vásquez EM, Chacón-Díaz R, Drenkard C. Early discoid lupus erythematosus protects against renal disease in patients with systemic lupus erythematosus: longitudinal data from a large Latin American cohort. Lupus 2016; 26:73-83. [DOI: 10.1177/0961203316651740] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/04/2016] [Indexed: 01/13/2023]
Abstract
Objectives The objective of this study was to examine whether early discoid lupus erythematosus (DLE) would be a protective factor for further lupus nephritis in patients with systemic lupus erythematosus (SLE). Methods We studied SLE patients from GLADEL, an inception longitudinal cohort from nine Latin American countries. The main predictor was DLE onset, which was defined as physician-documented DLE at SLE diagnosis. The outcome was time from the diagnosis of SLE to new lupus nephritis. Univariate and multivariate survival analyses were conducted to examine the association of DLE onset with time to lupus nephritis. Results Among 845 GLADEL patients, 204 (24.1%) developed lupus nephritis after SLE diagnosis. Of them, 10 (4.9%) had DLE onset, compared to 83 (12.9%) in the group of 641 patients that remained free of lupus nephritis (hazard ratio 0.39; P = 0.0033). The cumulative proportion of lupus nephritis at 1 and 5 years since SLE diagnosis was 6% and 14%, respectively, in the DLE onset group, compared to 14% and 29% in those without DLE ( P = 0.0023). DLE onset was independently associated with a lower risk of lupus nephritis, after controlling for sociodemographic factors and disease severity at diagnosis (hazard ratio 0.38; 95% confidence interval 0.20–0.71). Conclusions Our data indicate that DLE onset reduces the risk of further lupus nephritis in patients with SLE, independently of other factors such as age, ethnicity, disease activity, and organ damage. These findings have relevant prognosis implications for SLE patients and their clinicians. Further studies are warranted to unravel the biological and environmental pathways associated with the protective role of DLE against renal disease in patients with SLE.
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Affiliation(s)
- G J Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Barcelona, Spain
| | - L D Aspey
- Department of Dermatology, Emory School of Medicine, Atlanta, USA
| | - G Bao
- Division of Rheumatology, Emory School of Medicine, Atlanta, USA
| | - B A Pons-Estel
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - D Wojdyla
- GLADEL Consultant, Universidad Nacional de Rosario, Rosario, Argentina
| | - V Saurit
- Servicio de Reumatología, Hospital Privado, Córdoba, Argentina
| | - A Alvarellos
- Servicio de Reumatología, Hospital Privado, Córdoba, Argentina
| | - F Caeiro
- Servicio de Reumatología, Hospital Privado, Córdoba, Argentina
| | | | - E I Sato
- Departamento de Medicina, Universidade Federal da São Paulo (UNIFESP), São Paulo, Brazil
| | - E R Soriano
- Sección de Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Fundación Dr Pedro M Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - L T L Costallat
- Divisao de Reumatologia, Universidade Estadual de Campinas, Campinas, Brazil
| | - O Neira
- Sección de Reumatología, Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - A Iglesias-Gamarra
- Facultad de Medicina, Universidad Nacional de Colombia, Bogota, Colombia
| | - G Reyes-Llerena
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba
| | - M H Cardiel
- Centro de Investigación Clínica de Morelia, Morelia, México
| | - E M Acevedo-Vásquez
- Servicio de Reumatología, Hospital Nacional ‘Guillermo Almenara Irigoyen’, School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - R Chacón-Díaz
- Servicio de Reumatología, Hospital Universitario, Caracas, Venezuela
| | - C Drenkard
- Division of Rheumatology, Emory School of Medicine, Atlanta, USA
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Pons-Estel GJ, Catoggio LJ, Cardiel MH, Bonfa E, Caeiro F, Sato E, Massardo L, Molina-Restrepo JF, Toledano MG, Barile-Fabris LA, Amigo MC, Acevedo-Vásquez EM, Abadi I, Wojdyla D, Alarcón-Riquelme ME, Alarcón GS, Pons-Estel BA. Lupus in Latin-American patients: lessons from the GLADEL cohort. Lupus 2015; 24:536-45. [PMID: 25697768 DOI: 10.1177/0961203314567753] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/18/2014] [Indexed: 01/04/2023]
Abstract
The need for comprehensive published epidemiologic and clinical data from Latin American systemic lupus erythematosus (SLE) patients motivated the late Dr Alarcón-Segovia and other Latin American professionals taking care of these patients to spearhead the creation of the G: rupo L: atino A: mericano D: e E: studio del L: upus (GLADEL) cohort in 1997. This inception cohort recruited a total of 1480 multiethnic (Mestizo, African-Latin American (ALA), Caucasian and other) SLE patients diagnosed within two years from the time of enrollment from 34 Latin American centers with expertise in the diagnosis and management of this disease. In addition to the initial 2004 description of the cohort, GLADEL has contributed to improving our knowledge about the course and outcome of lupus in patients from this part of the Americas. The major findings from this cohort are highlighted in this review. They have had important clinical implications for the adequate care of SLE patients both in Latin America and worldwide where these patients may have emigrated.
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Affiliation(s)
- G J Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Spain
| | - L J Catoggio
- Sección de Reumatología, Servicio de Clínica Médica; Hospital Italiano and Fundación Dr Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - M H Cardiel
- Centro de Investigación Clínica de Morelia SC, Morelia, Michoacán, México
| | - E Bonfa
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - F Caeiro
- Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | - E Sato
- Disciplina de Reumatología, Escola Paulista de Medicina, Universidade Federal da São Paulo (UNIFESP), São Paulo, Brazil
| | - L Massardo
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - M Guibert Toledano
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba
| | - L A Barile-Fabris
- Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México Distrito Federal, México
| | - M C Amigo
- Reumatología, Centro Médico ABC, Ciudad de México, México
| | - E M Acevedo-Vásquez
- Servicio de Reumatología, Hospital Nacional 'Guillermo Almenara Irigoyen', Essalud, Lima, Perú
| | - I Abadi
- Unidad de Reumatología del Hospital de Clínicas Caracas, Venezuela
| | - D Wojdyla
- Escuela de Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | - M E Alarcón-Riquelme
- Centro Pfizer-Universidad de Granada-Junta de Andalucía de Gemómica e Investigaciones Oncológicas, Granada, Spain, and Oklahoma Medical Research Foundation, Oklahoma City, USA
| | - G S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Catoggio LJ, Soriano ER, Imamura PM, Wojdyla D, Jacobelli S, Massardo L, Chacón Díaz R, Guibert-Toledano M, Alvarellos A, Saurit V, Manni JA, Pascual-Ramos V, Silva de Sauza AW, Bonfa E, Tavares Brenol JC, Ramirez LA, Barile-Fabris LA, De La Torre IG, Alarcón GS, Pons-Estel BA. Late-onset systemic lupus erythematosus in Latin Americans: a distinct subgroup? Lupus 2014; 24:788-95. [PMID: 25504653 DOI: 10.1177/0961203314563134] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/15/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the characteristics of patients who developed late onset systemic lupus erythematosus (SLE) in the GLADEL (Grupo Latino Americano de Estudio del Lupus) cohort of patients with SLE. METHODS Patients with SLE of less than two years of disease duration, seen at 34 centers of nine Latin American countries, were included. Late-onset was defined as >50 years of age at time of first SLE-related symptom. Clinical and laboratory manifestations, activity index (SLEDAI), and damage index (SLICC/ACR- DI) were ascertained at time of entry and during the course (cumulative incidence). Features were compared between the two patient groups (<50 and ≥50) using descriptive statistics and hypothesis tests. Logistic regression was performed to examine the association of late-onset lupus, adjusting for other variables. RESULTS Of the 1480 patients included, 102 patients (6.9 %) had late-onset SLE, 87% of which were female. Patients with late-onset SLE had a shorter follow-up (3.6 vs. 4.4 years, p < 0.002) and a longer time to diagnosis (10.1 vs. 5.8 months, p < 0.001) compared to the younger onset group. Malar rash, photosensitivity, and renal involvement were less prevalent while interstitial lung disease, pleural effusions, and sicca symptoms were more frequent in the older age group (p > 0.05). In multivariable analysis, late onset was independently associated with higher odds of ocular (OR = 3.66, 95% CI = 2.15-6.23), pulmonary (OR = 2.04, 95% CI = 1.01-4.11), and cardiovascular (OR = 1.76, 95% CI = 1.04-2.98) involvement and lower odds of cutaneous involvement (OR = 0.41, 95% CI = 0.21-0.80), number of cumulative SLE criteria (OR = 0.79, 95% CI = 0.64-0.97), use of cyclophosphamide (OR = 0.47, 95% CI = 0.24-0.95), and anti-RNP antibodies (OR = 0.43, 95% CI = 0.20-0.91). A Cox regression model revealed a higher risk of dying in older onset than the younger-onset SLE (OR = 2.61, 95% CI = 1.2-5.6). CONCLUSION Late-onset SLE in Latin Americans had a distinct disease expression compared to the younger-onset group. The disease seems to be mild with lower cumulative SLE criteria, reduced renal/mucocutaneous involvements, and less use of cyclophosphamide. Nevertheless, these patients have a higher risk of death and of ocular, pulmonary, and cardiovascular involvements.
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Affiliation(s)
- L J Catoggio
- Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - E R Soriano
- Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - P M Imamura
- Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - D Wojdyla
- Universidad Nacional de Rosario, Rosario, Argentina
| | - S Jacobelli
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - L Massardo
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Chacón Díaz
- Hospital Universitario de Caracas, Caracas, Venezuela
| | | | - A Alvarellos
- Servicio de Reumatología, Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | - V Saurit
- Servicio de Reumatología, Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | - J A Manni
- Instituto de Investigaciones Médicas "Alfredo Lanari", Buenos Aires, Argentina
| | - V Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México Distrito Federal, Mexico
| | | | - E Bonfa
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - J C Tavares Brenol
- Hospital das Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - L A Ramirez
- Universidad de Antioquia, Hospital Universitario "Fundación San Vicente", Medellín, Colombia
| | - L A Barile-Fabris
- Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México Distrito Federal, Mexico
| | - I Garcia De La Torre
- Hospital General de Occidente de la Secretaría de Salud, Guadalajara, Jalisco, Mexico
| | - G S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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Pons-Estel GJ, Wojdyla D, McGwin G, Magder LS, Petri MA, Pons-Estel BA, Alarcón GS. The American College of Rheumatology and the Systemic Lupus International Collaborating Clinics Classification criteria for systemic lupus erythematosus in two multiethnic cohorts: a commentary. Lupus 2014; 23:3-9. [DOI: 10.1177/0961203313512883] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
The authors offer some comments on the advantages and possible drawbacks of using the SLICC criteria in longitudinal observational studies and clinical trials after applying and comparing them to the ACR criteria in two multinational, multiethnic lupus cohorts.
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Affiliation(s)
- GJ Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Spain
- Departments of Medicine, (Division of Clinical Immunology and Rheumatology) and Epidemiology, Schools of Medicine and Public Health, The University of Alabama at Birmingham, USA
| | - D Wojdyla
- Escuela de Estadística, Universidad Nacional de Rosario, Argentina
| | - G McGwin
- Departments of Medicine, (Division of Clinical Immunology and Rheumatology) and Epidemiology, Schools of Medicine and Public Health, The University of Alabama at Birmingham, USA
| | - LS Magder
- University of Maryland Dental School, USA
| | - MA Petri
- Johns Hopkins University School of Medicine, USA
| | | | - GS Alarcón
- Departments of Medicine, (Division of Clinical Immunology and Rheumatology) and Epidemiology, Schools of Medicine and Public Health, The University of Alabama at Birmingham, USA
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Lopes RD, Garcia DA, Wojdyla D, Dorian P, Alexander JH, Wallentin L, Lanas F, Hanna M, Held C, Granger CB. Use of apixaban and warfarin in patients undergoing invasive procedures: insights from ARISTOTLE. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Goto S, Zhu J, Lisheng L, Oh BH, Wojdyla D, Hanna M, Horowitz J, Wallentin L, Xavier D, Alexander JH. Efficacy and safety of apixaban compared with warfarin for stroke prevention in atrial fibrillation in East Asia. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Lopes R, Garcia D, Wojdyla D, Dorian P, Alexander J, Wallentin L, Lanas F, Hanna M, Held C, Granger C. Use of Apixaban and Warfarin in Patients Undergoing Invasive Procedures: Insights From Aristotle. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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14
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Turok DK, Godfrey EM, Wojdyla D, Dermish A, Torres L, Wu SC. Copper T380 intrauterine device for emergency contraception: highly effective at any time in the menstrual cycle. Hum Reprod 2013; 28:2672-6. [DOI: 10.1093/humrep/det330] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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15
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Held C, Hylek EB, Alexander JH, Hanna M, Lopes RD, Wojdyla D, Granger CB, Wallentin L. Risk of events in the 30 days following a major bleed with Apixaban or Warfarin - experiences from the ARISTOTLE trial. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pons-Estel GJ, Alarcón GS, Burgos PI, Hachuel L, Boggio G, Wojdyla D, Nieto R, Alvarellos A, Catoggio LJ, Guibert-Toledano M, Sarano J, Massardo L, Vásquez GM, Iglesias-Gamarra A, Lavras Costallat LT, Da Silva NA, Alfaro JL, Abadi I, Segami MI, Huerta G, Cardiel MH, Pons-Estel BA. Mestizos with systemic lupus erythematosus develop renal disease early while antimalarials retard its appearance: data from a Latin American cohort. Lupus 2013; 22:899-907. [PMID: 23857989 DOI: 10.1177/0961203313496339] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this paper is to assess the predictors of time-to-lupus renal disease in Latin American patients. METHODS Systemic lupus erythematosus (SLE) patients (n = 1480) from Grupo Latino Americano De Estudio de Lupus (GLADEL's) longitudinal inception cohort were studied. Endpoint was ACR renal criterion development after SLE diagnosis (prevalent cases excluded). Renal disease predictors were examined by univariable and multivariable Cox proportional hazards regression analyses. Antimalarials were considered time dependent in alternative analyses. RESULTS Of the entire cohort, 265 patients (17.9%) developed renal disease after entering the cohort. Of them, 88 (33.2%) developed persistent proteinuria, 44 (16.6%) cellular casts and 133 (50.2%) both; 233 patients (87.9%) were women; mean (± SD) age at diagnosis was 28.0 (11.9) years; 12.2% were African-Latin Americans, 42.5% Mestizos, and 45.3% Caucasians (p = 0.0016). Mestizo ethnicity (HR 1.61, 95% CI 1.19-2.17), hypertension (HR 3.99, 95% CI 3.02-5.26) and SLEDAI at diagnosis (HR 1.04, 95% CI 1.01-1.06) were associated with a shorter time-to-renal disease occurrence; antimalarial use (HR 0.57, 95% CI 0.43-0.77), older age at onset (HR 0.90, 95% CI 0.85-0.95, for every five years) and photosensitivity (HR 0.74, 95% CI 0.56-0.98) were associated with a longer time. Alternative model results were consistent with the antimalarial protective effect (HR 0.70, 95% CI 0.50-0.99). CONCLUSIONS Our data strongly support the fact that Mestizo patients are at increased risk of developing renal disease early while antimalarials seem to delay the appearance of this SLE manifestation. These data have important implications for the treatment of these patients regardless of their geographic location.
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Affiliation(s)
- G J Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Villarroel 170, Barcelona, Catalonia, Spain.
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17
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Pons-Estel GJ, Saurit V, Alarcón GS, Hachuel L, Boggio G, Wojdyla D, Alfaro-Lozano JL, de la Torre IG, Massardo L, Esteva-Spinetti MH, Guibert-Toledano M, Gómez LAR, Costallat LTL, Del Pozo MJS, Silveira LH, Cavalcanti F, Pons-Estel BA. The impact of rural residency on the expression and outcome of systemic lupus erythematosus: data from a multiethnic Latin American cohort. Lupus 2012; 21:1397-404. [PMID: 22941567 DOI: 10.1177/0961203312458465] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this paper is to examine the role of place of residency in the expression and outcomes of systemic lupus erythematosus (SLE) in a multi-ethnic Latin American cohort. PATIENTS AND METHODS SLE patients (< two years of diagnosis) from 34 centers constitute this cohort. Residency was dichotomized into rural and urban, cut-off: 10,000 inhabitants. Socio-demographic, clinical/laboratory and mortality rates were compared between them using descriptive tests. The influence of place of residency on disease activity at diagnosis and renal disease was examined by multivariable regression analyses. RESULTS Of 1426 patients, 122 (8.6%) were rural residents. Their median ages (onset, diagnosis) were 23.5 and 25.5 years; 85 (69.7%) patients were Mestizos, 28 (22.9%) Caucasians and 9 (7.4%) were African-Latin Americans. Rural residents were more frequently younger at diagnosis, Mestizo and uninsured; they also had fewer years of education and lower socioeconomic status, exhibited hypertension and renal disease more frequently, and had higher levels of disease activity at diagnosis; they used methotrexate, cyclophosphamide pulses and hemodialysis more frequently than urban patients. Disease activity over time, renal damage, overall damage and the proportion of deceased patients were comparable in rural and urban patients. In multivariable analyses, rural residency was associated with high levels of disease activity at diagnosis (OR 1.65, 95% CI 1.06-2.57) and renal disease occurrence (OR 1.77, 95% CI 1.00-3.11). CONCLUSIONS Rural residency associates with Mestizo ethnicity, lower socioeconomic status and renal disease occurrence. It also plays a role in disease activity at diagnosis and kidney involvement but not on the other end-points examined.
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Affiliation(s)
- G J Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Spain.
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Rodriguez MI, Seuc A, Kapp N, von Hertzen H, Huong NTM, Wojdyla D, Mittal S, Arustamyan K, Shah R. Acceptability of misoprostol-only medical termination of pregnancy compared with vacuum aspiration: an international, multicentre trial. BJOG 2012; 119:817-23. [DOI: 10.1111/j.1471-0528.2012.03310.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Wu S, Godfrey EM, Wojdyla D, Dong J, Cong J, Wang C, von Hertzen H. Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial. BJOG 2010; 117:1205-10. [DOI: 10.1111/j.1471-0528.2010.02652.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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von Hertzen H, Piaggio G, Wojdyla D, Marions L, My Huong NT, Tang OS, Fang AH, Wu SC, Kalmar L, Mittal S, Erdenetungalag R, Horga M, Pretnar-Darovec A, Kapamadzija A, Dickson K, Anh ND, Tai NV, Tuyet HTD, Peregoudov A. Two mifepristone doses and two intervals of misoprostol administration for termination of early pregnancy: a randomised factorial controlled equivalence trial. BJOG 2009; 116:381-9. [PMID: 19187370 DOI: 10.1111/j.1471-0528.2008.02034.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the efficacy of 100 mg and 200 mg of mifepristone and 24- and 48-hour intervals to administration of 800 microg vaginal misoprostol for termination of early pregnancy. DESIGN Placebo-controlled, randomized, equivalence trial, stratified by centre. SETTING 13 departments of obstetrics and gynecology in nine countries. POPULATION 2,181 women with 63 days or less gestation requesting medical abortion. METHODS Two-sided 95% CI for the risk differences of failure to complete abortion were calculated and compared with 5% equivalence margin between two doses of mifepristone and two intervals to misoprostol administration. Proportions of women with adverse effects were compared between the regimens using standard testes for proportions. OUTCOME MEASURES Rates of complete abortion without surgical intervention and adverse effects associated with the regimens. RESULTS Efficacy outcome was analysed for 2,126 women (97.5%) excluding 55 lost to follow up. Both mifepristone doses were found to be similar in efficacy. The rate of complete abortion was 92.0% for women assigned 100 mg of mifepristone and 93.2% for women assigned 200 mg of mifepristone (difference 1.2%, 95% CI: -1.0 to 3.5). Equivalence was also evident for the two intervals of administration: the rate of complete abortion was 93.5% for 24-hour interval and 91.7% for the 48-hour interval (difference -1.8%, 95% CI: -4.0 to 0.5). Interaction between doses and interval to misoprostol administration was not significant (P = 0.92). Adverse effects related to treatments did not differ between the groups. CONCLUSIONS Both the 100 and 200 mg doses of mifepristone and the 24- and 48-hour intervals have a similar efficacy to achieve complete abortion in early pregnancy when mifepristone is followed by 800 micrograms of vaginally administered misoprostol.
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Affiliation(s)
- H von Hertzen
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland.
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Ramírez Gómez LA, Uribe Uribe O, Osio Uribe O, Grisales Romero H, Cardiel MH, Wojdyla D, Pons-Estel BA, Catoggio LJ, Soriano ER, Imamura PM, Manni JA, Grimaudo S, Sarano J, Maldonado-Cocco JA, Arriola MS, Gómez G, García MA, Marcos AI, Marcos JC, Scherbarth HR, Marino PC, Motta EL, Drenkard C, Gamron S, Buliubasich S, Onetti CM, Caeiro F, Alvarellos A, Saurit V, Gentiletti S, Quagliatto N, Gentiletti AA, Machado D, Abdala M, Palatnik S, Berbotto GA, Battagliotti CA, Sato E, Sella EMC, Souza AS, Costallat LTL, Bertolo MB, Coimbra IB, Borba Neto EF, Bonfá E, Tavares JC, Brenol, Xavier R, Mucenic T, Cavalcanti FDS, Duarte ALB, Marques CDL, Da Silva NA, de O e Silva AC, Pacheco TF, Molina-Restrepo JF, Molina-López J, Iglesias-Gamarra A, Iglesias-Rodríguez A, Egea-Bermejo E, Guzmán-Moreno RA, Restrepo-Suárez JF, Guibert-Toledano M, Reyes-Llerena GA, Massardo L, Gareca N, Jacobelli S, Neira OJ, Guzmán LR, Garcia-Kutzbach A, Castellanos C, Cajas E, Pascual-Ramos V, Barile-Fabris LA, Miranda-Limón JM, Amigo MC, Silveira LH, De La Torre IG, Orozco-Barocio G, Estrada-Contreras ML, del Pozo MJS, Aranda Baca LE, Quezada AU, Huerta-Yáñez GF, Acevedo-Vásquez EM, Alfaro-Lozano JL, Cucho-Venegas JM, Segami MI, Chung CP, Alva-Linares M, Abadi I, Chacón-Díaz R, Al Snih Al Snih S, Esteva-Spinetti MH, Vivas J. Childhood systemic lupus erythematosus in Latin America. The GLADEL experience in 230 children. Lupus 2008; 17:596-604. [PMID: 18539716 DOI: 10.1177/0961203307088006] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate disease characteristics of childhood onset SLE in Latin America and to compare this information with an adult population in the same cohort of GLADEL. A protocol was designed as a multicenter, multinational, inception cohort of lupus patients to evaluate demographic, clinical, laboratory and serological variables, as well as classification criteria, disease activity, organ damage and mortality. Descriptive statistics, chi square, Fisher's exact test, Student's t test and multiple logistic regression were used to compare childhood and adult onset SLE. 230 patients were <18 years and 884 were adult SLE patients. Malar rash, fever, oral ulcers, thrombocytopenia and hemolytic anemia and some neurologic manifestations were more prevalent in children (p<0.05). On the other hand, myalgias, Sjögren's syndrome and cranial nerve involvement were more frequently seen in adults (p<0.05). Afro-Latin-American children had a higher prevalence of fever, thrombocytopenia and hemolytic anemia. White and mestizo children had a higher prevalence of malar rash. Mestizo children had a higher prevalence of cerebrovascular disease and cranial nerve involvement. Children met SLE ACR criteria earlier with higher mean values than adults (p: 0.001). They also had higher disease activity scores (p: 0.01), whereas adults had greater disease damage (p: 0.02). In Latin America, childhood onset SLE seems to be a more severe disease than adults. Some differences can be detected among ethnic groups.
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Affiliation(s)
- L A Ramírez Gómez
- Sección de Reumatología, Universidad de Antioquia, Hospital Universitario San Vicente de Paúl. Medellín, Colombia.
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22
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von Hertzen H, Piaggio G, Wojdyla D, Huong NTM, Marions L, Okoev G, Khomassuridze A, Kereszturi A, Mittal S, Nair R, Daver R, Pretnar-Darovec A, Dickson K, Hinh ND, Bao NH, Tuyet HTD, Peregoudov A. Comparison of vaginal and sublingual misoprostol for second trimester abortion: randomized controlled equivalence trial. Hum Reprod 2008; 24:106-12. [DOI: 10.1093/humrep/den328] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Fontanella GH, Pascutti MF, Daurelio L, Perez AR, Nocito AL, Wojdyla D, Bottasso O, Revelli SS, Stanford JL. Improved outcome of Trypanosoma cruzi infection in rats following treatment in early life with suspensions of heat-killed environmental Actinomycetales. Vaccine 2006; 25:3492-500. [PMID: 17368877 DOI: 10.1016/j.vaccine.2006.11.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 11/20/2006] [Accepted: 11/28/2006] [Indexed: 01/12/2023]
Abstract
The well-established model of Chagas' disease in "l" rats was used to evaluate the effects of three injections of heat-killed Gordonia bronchialis, Rhodococcus coprophilus or saline on Trypanosoma cruzi parasitaemia and acute and chronic myocarditis, sequelae of the infection. Two vaccinating injections were given prior to challenge with T. cruzi, and the third, immunotherapeutic, injection was given 7 days after challenge. Treatment with either actinomycete significantly reduced acute parasitaemia (p<0.04), modified cellular infiltration during acute myocarditis and limited chronic myocarditis (p<0.03) in comparison with the saline-treated control animals. Immunological investigations showed that both bacterial preparations achieved their results through different mechanisms. The relevance of our findings to human Chagas' disease is discussed.
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Affiliation(s)
- G H Fontanella
- Instituto de Inmunología, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Santa Fe 3100, 2000 Rosario, Santa Fe, Argentina
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24
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Garcia MA, Marcos JC, Marcos AI, Pons-Estel BA, Wojdyla D, Arturi A, Babini JC, Catoggio LJ, Alarcon-Segovia D. Male systemic lupus erythematosus in a Latin-American inception cohort of 1214 patients. Lupus 2006; 14:938-46. [PMID: 16425573 DOI: 10.1191/0961203305lu2245oa] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The objective of the study was to evaluate the influence of the male gender in the clinical presentation and outcome of systemic lupus erythematosus in a prospective inception cohort of Latin-American patients. Of the 1214 SLE patients included in the GLADEL cohort, 123 were male. Demographic characteristics as well as clinical manifestations, laboratory profile, activity and damage scores were evaluated at onset and during the course of the disease and compared with female patients. The median age at onset of the male patients was 27 and that at diagnosis 29.2 years. Delay to diagnosis was shorter in males (134 versus 185 days, P = 0.01). At onset, men more frequently showed fever (42.3 versus 27.0%, P = 0.001) and weight loss (23.6 versus 11.8%, P = 0.001). During disease course the incident of symptoms was: fever, 67.8 versus 55.6%, P = 0.012; weight loss, 47.2 versus 24.3%, P = 0.001; arterial hypertension, 37.4 versus 25.8%, P = 0.007; renal disease (persistent proteinuria and/or cellular casts), 58.5 versus 44.6%, P = 0.004); and hemolytic anemia, 19.5 versus 10.9%, P = 0.008. The laboratory results showed that: men more frequently had IgG anticardiolipin antibodies (68.2 versus 49%, P = 0.02) and low C3 (61.3 versus 48.1%, P = 0.03); 5/123 men died (4%) compared with 29/1091 women (2.7%). In conclusion, 10% of GLADEL's cohort patients were male. They showed a distinctive profile with shorter delay to diagnosis, higher incidence of fever, weight loss, arterial hypertension, renal disease, hemolytic anemia, IgG anticardiolipin antibodies and low C3. Although not statistically significant, mortality was higher in men.
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Affiliation(s)
- M A Garcia
- Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina.
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25
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Abstract
One approach to analyse geographic variations of a disease within a country is through mortality rates in administrative areas. In some geographical areas the rates can be unstable due to their low population. Thus, the statistical analysis of the rate could be not significant due to low population, not because of the real value. An alternative approach to this problem is to set a minimum level of population that enables valid statistical comparisons with the national rate to be made. It is decided to apply an algorithm that groups neighbouring geographical units that reach the minimum population. In the resulting regions, mortality rates are calculated, and the geographic patterns are analysed through the Moran's I coefficient of spatial clustering. This paper presents an application of this approach to mortality rates from breast cancer by Argentine departments, political administrative units into which a province is divided. Applying this procedure, 217 regions were obtained. In two of the regions the rates were significantly higher than the national rate, while in 40 regions they were significantly lower. Significant spatial grouping, reflected by a Moran I coefficient of O-47, was observed.
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Affiliation(s)
- D Wojdyla
- Division Immunologia, Fac. de Ciencias Medicas, Universidad Nacional de Rosario, Sante Fe, Rosario, Argentina
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