CARLA GONCALVES SCHAHIN SAAD

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 1 Citação(ões) na Scopus
    HLA-B27 positivity in a large miscegenated population of 5,389,143 healthy blood marrow donors in Brazil
    (2023) RESENDE, Gustavo Gomes; SAAD, Carla Goncalves Schahin; OLIVEIRA, Danielli Cristina Muniz de; BUENO FILHO, Julio Silvio de Sousa; SAMPAIO-BARROS, Percival Degrava; PINHEIRO, Marcelo de Medeiros
    BackgroundThe prevalence of HLA-B27 gene positivity in healthy Caucasian communities varies between 8 and 14%. However, there is a lack of information in countries with a high rate of miscegenation, such as Brazil.AimTo estimate the frequency of HLA-B27 in the Brazilian general population using a large national registry database.MethodsThis is a cross-sectional ecological study using the Brazilian Registry of Volunteer Bone Marrow Donors (REDOME) database on HLA-B27 allelic frequency and proportion of positives of healthy donors (18-60 years old). Data were analyzed according to sex, age, race (by self-reported skin color recommended by the Brazilian Institute of Geography and Statistics - IBGE), and geographic region of residence.ResultsFrom 1994 to 2022, a total of 5,389,143 healthy bone marrow donors were included. The overall positivity for HLA-B27 was 4.35% (CI 95% 4.32-4.37%), regardless of sex and age (57.2% were women, mean age was 41.7yo). However, there was a difference between races: 4.85% in Whites; 2.92% in Blacks; 3.76% in Pardos (Browns i.e. mixed races); 3.95% in Amarelos (Yellows i.e. Asian Brazilians); and 3.18% in Indigenous. There was also a difference regarding geographic region of residence (North: 3.62%; Northeast: 3.63%; Southeast: 4.29%; Midwest: 4.5% and 5.25% in South). The homozygosity rate for the HLA-B27 was 1.32% of all the positives and only 0.06% in the general population.ConclusionsOur findings provide the first Brazilian national prevalence for HLA-B27 in 4.35%. There is a gradient gene positivity from North to South, suggesting that the genetic background related to the miscegenation due to colonization, slavery, and some later waves of immigration together with internal migratory flows, could explain our findings.
  • article 0 Citação(ões) na Scopus
    No Associations Between Physical Activity and Immunogenicity in SARS-CoV-2 Seropositive Patients With Autoimmune Rheumatic Diseases Prior to and After Vaccination
    (2023) SMAIRA, Fabiana Infante; MAZZOLANI, Bruna Caruso; LEMES, italo Ribeiro; SILVA, Rafael Pires da; PINTO, Ana J.; SIECZKOWSKA, Sofia M.; AIKAWA, Nadia E.; PASOTO, Sandra G.; MEDEIROS-RIBEIRO, Ana C.; SAAD, Carla G. S.; YUK, Emily F. N.; SILVA, Clovis A.; SWINTON, Paul; KUPA, Leonard de Vinci Kanda; HALLAL, Pedro C.; ROSCHEL, Hamilton; GUALANO, Bruno; BONFA, Eloisa
    Aim: To investigate the association between physical activity and immunogenicity among SARS-CoV-2 seropositive patients with autoimmune rheumatic diseases prior to and following a 2-dose schedule of CoronaVac (Sinovac inactivated vaccine). Methods: This was a prospective cohort study within an open-label, single-arm, phase 4 vaccination trial conducted in Sao Paulo, Brazil. In this substudy, only SARS-CoV-2 seropositive patients were included. Immunogenicity was assessed by seroconversion rates of total anti-SARS-CoV-2 S1/S2 immunoglobulin G (IgG), geometric mean titers of anti-S1/S2 IgG, frequency of positive neutralizing antibodies, and neutralizing activity before and after vaccination. Physical activity was assessed through a questionnaire. Model-based analyses were performed controlling for age (<60 or>_60 y), sex, body mass index (<25, 25-30, and >30 kg/m2), and use of prednisone, immunosuppressants, and biologics. Results: A total of 180 seropositive autoimmune rheumatic disease patients were included. There was no association between physical activity and immunogenicity before and after vaccination. Conclusions: This study suggests that the positive association between physical activity and greater antibody responses seen in immunocompromised individuals following vaccination is overridden by previous SARS-CoV-2 infection, and does not extend to natural immunity.
  • article 1 Citação(ões) na Scopus
    Anti-SARS-CoV-2 inactivated vaccine in patients with ANCA-associated vasculitis: Immunogenicity, safety, antibody decay and the booster dose
    (2023) PEREIRA, Rosa M. R.; DAGOSTIN, Marilia A.; CAPARBO, Valeria F.; SALES, Lucas P.; PASOTO, Sandra G.; SILVA, Clovis A.; YUKI, Emily F. N.; SAAD, Carla G. S.; MEDEIROS-RIBEIRO, Ana C.; KUPA, Leonard V. K.; FUSCO, Solange R. G.; MARTINS, Victor A. O.; MARTINS, Carolina C. M. F.; BARBAS, Carmen Valente; SHINJO, Samuel K.; AIKAWA, Nadia E.; BONFA, Eloisa
    Objective: To evaluate inactivated CoronaVac prime vaccination, antibody decay, booster dose, and safety in ANCA-Associated Vasculitis (AAV) patients.Methods: Fifty-three AAV patients and 106 Controls (CG) received CoronaVac on days: D0 (first dose), D28(second dose), and D210 (booster dose, 32 AAV: 32 CG). The primary outcome was immunogenicity after the second vac-cine dose (day 69) assessed by Seroconversion Rates (SC) of anti-SARS-CoV-2 S1/S2 IgG and Neutralizing Anti-bodies (NAb). Secondary outcomes were safety, immunogenicity (D28/D240), 6-months antibody decay (D210) and the booster dose response (D240).Results: At D69 SC (65.1% vs. 96.8%, p = 0.0001), GMT (21.3 UA/mL vs. 67.7 UA/mL, p < 0.001) and NAb- posi-tivity (53.7% vs. 80.6%, p = 0.001) were moderate but lower in naive-AAV patients than CG. Patients without SC used more often IS (93.3% vs. 53.3%, p = 0.015), mycophenolate mofetil (20% vs. 0%, p = 0.037) and predni-sone (60.0% vs. 28.6%, p = 0.057) than seroconverted. NAb negativity in AAV patients was associated with pred-nisone treatment (57.9% vs. 18.2%, p = 0.015) and IS (84.2% vs. 55.0%, p = 0.046). Logistic regression analysis models showed that only prednisone was associated with lower seroconversion (OR = 0.2, 0,95% CI 0.05-0.86, p = 0.030) and with lower NAb positivity (OR = 0.2, 0,95% CI 0.05-0.88, p = 0.034). After six months (D69 -D210) a decrease in IgG positivity occurred in 32 AAV patients (15.7%, p = 0.074) and 32 CG (18.7%, p = 0.041). For the NAb positivity, the 6-month decrease was not significant (p = 0.114) whereas a major reduc-tion occurred for CG (p < 0.001). A booster dose (D240) resulted in an increment in IgG-positivity (21.9%, p = 0.023) and NAb-positivity (34.4%, p = 0.006) in AAV patients. No moderate/severe adverse events attribut-able to the vaccine were observed.Conclusion: This study provides novel data on the excellent safety and moderate immunogenicity of CoronaVac in AAV patients. A six-month mild antibody waning was observed with a good response to the booster dose, although levels remained lower than CG (CoronavRheum-NCT04754698).
  • article 8 Citação(ões) na Scopus
    Interaction of TNFi and conventional synthetic DMARD in SARS-CoV-2 vaccine response in axial spondyloarthritis and psoriatic arthritis
    (2023) SAAD, Carla G. S.; SILVA, Matheus S. R.; SAMPAIO-BARROS, Percival D.; MORAES, Julio C. B.; SCHAINBERG, Claudia G.; GONCALVES, Celio R.; SHIMABUCO, Andrea Y.; AIKAWA, Nadia E.; YUKI, Emily F. N.; PASOTO, Sandra G.; KUPA, Leonard V. K.; AOYAMA, Renato K.; ARAUJO, Carlo S. R.; SILVA, Clovis A.; MEDEIROS-RIBEIRO, Ana C.; BONFA, Eloisa
    Objectives: To evaluate humoral responses to three doses of the inactivated SARS-CoV-2 vaccine (CoronaVac) in patients with spondyloarthritis (SpA) and the effect of therapy, compared with a control group (CG).Methods: Prospective cohort of axial SpA/psoriatic arthritis patients and age/sex-balanced CG from the CoronavRheum phase 4 trial (NCT04754698). CoronaVac was given in two doses (28-days interval) with a booster at day 210. Blood samples were collected in the days 0/28 (D28)/69 (D69) and 240 (D240) to evaluate anti-SARS-CoV-2 IgG seropositivity (SP) and neutralising antibodies (NAb).Results: One hundred and ninety-four SpA patients were enrolled and 183 patients were age/sex-balanced with 183 CG. At D69, SpA patients showed a high SP (80.2% vs. 95.7%, P < 0.001) and moderate NAb positivity (61.6% vs. 82.7%, P < 0.001), but lower than CG. In patients, older age prednisone (P < 0.001), methotrexate (MTX) (P < 0.001) and TNF inhibitors (TNFi) (P < 0.001) were independently associated with lower SP, while Caucasian ethnicity (P < 0.05) and prednisone (P < 0.01) were associated with diminished NAb. In contrast, sulfasalazine (SSZ) use was associated with NAb presence (P < 0.05). In monotherapy, only TNFi was also associated with absence of SP (P < 0.05). Further comparison with CG revealed that TNFi and/or MTX negatively impacted SP/NAb (P < 0.05). In contrast, patients under SSZ monotherapy achieved 100% SP (P > 0.999) and 83.3% NAb positivity (P > 0.999). SSZ + TNFi combination resulted in a similar response than CG [SP (P = 0.153) and NAb (P = 0.715)]. After third dose (D69-D240), a major increment occurred for SP (81.3% to 93.1%, P < 0.001) and NAb (63.2% to 86.1%, P < 0.001), but still lower than CG (P < 0.05), and only TNFi impaired both SP (P = 0.016)/NAb (P = 0.002).Conclusions: We provided novel data demonstrating that TNFi attenuates immunogenicity in SpA patients while SSZ has a positive impact on vaccine antibody production. We also confirmed that MTX in combination with TNFi had a major negative impact in vaccine humoral response (CoronavRheum clinicaltrials.gov #NCT04754698).(c) 2022 Socie acute accent te acute accent franc , aise de rhumatologie.
  • article 0 Citação(ões) na Scopus
    Physical Activity: A Strategy to Improve Antibody Response to a SARS-CoV-2 Vaccine Booster Dose in Patients With Autoimmune Rheumatic Diseases
    (2023) GUALANO, Bruno; SIECZKOWSKA, Sofia M.; LEMES, Italo Ribeiro; SILVA, Rafael Pires da; PINTO, Ana J.; MAZZOLANI, Bruna C.; SMAIRA, Fabiana I.; AIKAWA, Nadia E.; KUPA, Leonard V. K.; PASOTO, Sandra G.; MEDEIROS-RIBEIRO, Ana C.; SAAD, Carla G. S.; YUK, Emily F. N.; SILVA, Clovis A.; SWINTON, Paul; HALLAL, Pedro C.; ROSCHEL, Hamilton; BONFA, Eloisa
    Background: Physical activity associates with improved immunogenicity following a 2-dose schedule of CoronaVac (Sinovac's inactivated SARS-CoV-2 vaccine) in patients with autoimmune rheumatic diseases (ARD). This study evaluates whether physical activity impacts vaccine-induced antibody responses to a booster dose in this population. Methods: This was a phase-4 trial conducted in Sao Paulo, Brazil. Patients with ARD underwent a 3-dose schedule of CoronaVac. One month after the booster, we assessed seroconversion rates of anti-SARS-CoV-2 S1/S2 IgG, geometric mean titers of anti-S1/S2 IgG, frequency of positive neutralizing antibodies, and neutralizing activity. Physical activity was assessed through questionnaire. Results: Physically active (n = 362) and inactive (n = 278) patients were comparable for most characteristics; however, physically active patients were younger (P<.01) and had a lower frequency of chronic inflammatory arthritis (P<.01). Adjusted models showed that physically active patients had -2 times odds of seroconversion rates (OR: 2.09; 95% confidence interval, 1.22 to 3.61), -22% greater geometric mean titers of anti-S1/S2 IgG (22.09%; 95% confidence interval, 3.91 to 65.60), and -7% greater neutralizing activity (6.76%; 95% confidence interval, 2.80 to 10.72) than inactive patients. Conclusions: Patients with ARD who are physically active have greater odds of experiencing better immunogenicity to a booster dose of CoronaVac. These results support the recommendation of physical activity to improve vaccination responses, particularly for immunocompromised individuals.
  • article 0 Citação(ões) na Scopus
    Post-acute COVID-19 in three doses vaccinated autoimmune rheumatic diseases patients: frequency and pattern of this condition
    (2023) SILVA, Clovis Artur; KUPA, Leonard de Vinci Kanda; MEDEIROS-RIBEIRO, Ana Cristina; PASOTO, Sandra Gofinet; SAAD, Carla Goncalves Schahin; YUKI, Emily Figueiredo Neves; LANDIM, Joaquim Ivo Vasques Dantas; LEDA, Victor Hugo Ferreira e; CORREIA, Luisa Sacchi de Camargo; SARTORI, Artur Fonseca; MARTINS, Carolina Campagnoli Machado Freire; RIBEIRO, Carolina Torres; WARIDEL, Filipe; MARTINS, Victor Adriano de Oliveira; SHINJO, Samuel Katsuyuki; ANDRADE, Danieli Castro Oliveira; BARROS, Percival Degrava Sampaio; NETO, Eduardo Ferreira Borba; AIKAWA, Nadia Emi; BONFA, Eloisa
    BackgroundData on post-acute COVID-19 in autoimmune rheumatic diseases (ARD) are scarce, focusing on a single disease, with variable definitions of this condition and time of vaccination. The aim of this study was to evaluate the frequency and pattern of post-acute COVID-19 in vaccinated patients with ARD using established diagnosis criteria.MethodsRetrospective evaluation of a prospective cohort of 108 ARD patients and 32 non-ARD controls, diagnosed with SARS-CoV-2 infection (RT-PCR/antigen test) after the third dose of the CoronaVac vaccine. Post-acute COVID-19 (>= 4 weeks and > 12 weeks of SARS-CoV-2 symptoms) were registered according to the established international criteria.ResultsARD patients and non-ARD controls, balanced for age and sex, had high and comparable frequencies of >= 4 weeks post-acute COVID-19 (58.3% vs. 53.1%, p = 0.6854) and > 12 weeks post-acute COVID-19 (39.8% vs. 46.9%, p = 0.5419). Regarding >= 4 weeks post-acute COVID-19, frequencies of >= 3 symptoms were similar in ARD and non-ARD controls (54% vs. 41.2%, p = 0.7886), and this was also similar in > 12 weeks post-acute COVID-19 (68.3% vs. 88.2%, p = 0.1322). Further analysis of the risk factors for >= 4 weeks post-acute COVID-19 in ARD patients revealed that age, sex, clinical severity of COVID-19, reinfection, and autoimmune diseases were not associated with this condition (p > 0.05). The clinical manifestations of post-acute COVID-19 were similar in both groups (p > 0.05), with fatigue and memory loss being the most frequent manifestations.ConclusionWe provide novel data demonstrating that immune/inflammatory ARD disturbances after third dose vaccination do not seem to be a major determinant of post-acute COVID-19 since its pattern is very similar to that of the general population. Clinical Trials platform (NCT04754698).
  • article 9 Citação(ões) na Scopus
    Characteristics associated with poor COVID-19 outcomes in people with psoriasis, psoriatic arthritis and axial spondyloarthritis: data from the COVID-19 PsoProtect and Global Rheumatology Alliance physician-reported registries
    (2023) MACHADO, Pedro M.; SCHAEFER, Martin; MAHIL, Satveer K.; LIEW, Jean; GOSSEC, Laure; DAND, Nick; PFEIL, Alexander; STRANGFELD, Anja; REGIERER, Anne Constanze; FAUTREL, Bruno; ALONSO, Carla Gimena; SAAD, Carla G. S.; GRIFFITHS, Christopher E. M.; LOMATER, Claudia; MICELI-RICHARD, Corinne; WENDLING, Daniel; RODRIGUEZ, Deshire Alpizar; WIEK, Dieter; MATEUS, Elsa F.; SIROTICH, Emily; SORIANO, Enrique R.; RIBEIRO, Francinne Machado; OMURA, Felipe; MARTINS, Frederico Rajao; SANTOS, Helena; DAU, Jonathan; BARKER, Jonathan N.; HAUSMANN, Jonathan; HYRICH, Kimme L.; GENSLER, Lianne; SILVA, Ligia; JACOBSOHN, Lindsay; CARMONA, Loreto; PINHEIRO, Marcelo M.; ZELAYA, Marcos David; SEVERINA, Maria de los Angeles; YATES, Mark; DUBREUIL, Maureen; GORE-MASSY, Monique; ROMEO, Nicoletta; HAROON, Nigil; SUFKA, Paul; GRAINGER, Rebecca; HASSELI, Rebecca; LAWSON-TOVEY, Saskia; BHANA, Suleman; PHAM, Thao; OLOFSSON, Tor; BAUTISTA-MOLANO, Wilson; WALLACE, Zachary S.; YIU, Zenas Z. N.; YAZDANY, Jinoos; ROBINSON, Philip C.; SMITH, Catherine H.
    ObjectivesTo investigate factors associated with severe COVID-19 in people with psoriasis (PsO), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). MethodsDemographic data, clinical characteristics and COVID-19 outcome severity of adults with PsO, PsA and axSpA were obtained from two international physician-reported registries. A three-point ordinal COVID-19 severity scale was defined: no hospitalisation, hospitalisation (and no death) and death. ORs were estimated using multivariable ordinal logistic regression. ResultsOf 5045 cases, 18.3% had PsO, 45.5% PsA and 36.3% axSpA. Most (83.6%) were not hospitalised, 14.6% were hospitalised and 1.8% died. Older age was non-linearly associated with COVID-19 severity. Male sex (OR 1.54, 95% CI 1.30 to 1.83), cardiovascular, respiratory, renal, metabolic and cancer comorbidities (ORs 1.25-2.89), moderate/high disease activity and/or glucocorticoid use (ORs 1.39-2.23, vs remission/low disease activity and no glucocorticoids) were associated with increased odds of severe COVID-19. Later pandemic time periods (ORs 0.42-0.52, vs until 15 June 2020), PsO (OR 0.49, 95% CI 0.37 to 0.65, vs PsA) and baseline exposure to TNFi, IL17i and IL-23i/IL-12+23i (OR 0.57, 95% CI 0.44 to 0.73; OR 0.62, 95% CI 0.45 to 0.87; OR 0.67, 95% CI 0.45 to 0.98; respectively; vs no disease-modifying antirheumatic drug) were associated with reduced odds of severe COVID-19. ConclusionOlder age, male sex, comorbidity burden, higher disease activity and glucocorticoid intake were associated with more severe COVID-19. Later pandemic time periods, PsO and exposure to TNFi, IL17i and IL-23i/IL-12+23i were associated with less severe COVID-19. These findings will enable risk stratification and inform management decisions for patients with PsO, PsA and axSpA during COVID-19 waves or similar future respiratory pandemics.