VILMA DOS SANTOS TRINDADE VIANA

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

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Autor e Coautores FMUSP-HC Normalizados: CARLA GONCALVES SCHAHIN SAAD ×

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  • article 80 Citação(ões) na Scopus
    Immunogenicity and safety of the 2009 non-adjuvanted influenza A/H1N1 vaccine in a large cohort of autoimmune rheumatic diseases
    (2011) SAAD, Carla G. S.; BORBA, Eduardo F.; AIKAWA, Nadia E.; SILVA, Clovis A.; PEREIRA, Rosa M. R.; CALICH, Ana Luisa; MORAES, Julio C. B.; RIBEIRO, Ana C. M.; VIANA, Vilma S. T.; PASOTO, Sandra G.; CARVALHO, Jozelio F.; FRANCA, Ivan L. A.; GUEDES, Lissiane K. N.; SHINJO, Samuel K.; SAMPAIO-BARROS, Percival D.; CALEIRO, Maria T.; GONCALVES, Celio R.; FULLER, Ricardo; LEVY-NETO, Mauricio; TIMENETSKY, Maria do Carmo S.; PRECIOSO, Alexander R.; BONFA, Eloisa
    Background Despite the WHO recommendation that the 2010-2011 trivalent seasonal flu vaccine must contain A/California/7/2009/H1N1-like virus there is no consistent data regarding its immunogenicity and safety in a large autoimmune rheumatic disease (ARD) population. Methods 1668 ARD patients (systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic sclerosis, psoriatic arthritis (PsA), Behcet's disease (BD), mixed connective tissue disease, primary antiphospholipid syndrome (PAPS), dermatomyositis (DM), primary Sjogren's syndrome, Takayasu's arteritis, polymyositis and Granulomatosis with polyangiitis (Wegener's) (GPA)) and 234 healthy controls were vaccinated with a non-adjuvanted influenza A/California/7/2009(H1N1) virus-like strain flu. Subjects were evaluated before vaccination and 21 days post-vaccination. The percentage of seroprotection, seroconversion and the factor increase in geometric mean titre (GMT) were calculated. Results After immunisation, seroprotection rates (68.5% vs 82.9% p < 0.0001), seroconversion rates (63.4% vs 76.9%, p < 0.001) and the factor increase in GMT (8.9 vs 13.2 p < 0.0001) were significantly lower in ARD than controls. Analysis of specific diseases revealed that seroprotection significantly reduced in SLE (p < 0.0001), RA (p < 0.0001), PsA (p=0.0006), AS (p=0.04), BD (p=0.04) and DM (p=0.04) patients than controls. The seroconversion rates in SLE (p < 0.0001), RA (p < 0.0001) and PsA (p=0.0006) patients and the increase in GMTs in SLE (p < 0.0001), RA (p < 0.0001) and PsA (p < 0.0001) patients were also reduced compared with controls. Moderate and severe side effects were not reported. Conclusions The novel recognition of a diverse vaccine immunogenicity profile in distinct ARDs supports the notion that a booster dose may be recommended for diseases with suboptimal immune responses. This large study also settles the issue of vaccine safety. (ClinicalTrials.gov #NCT01151644)
  • conferenceObject
    TESTICULAR SERTOLI CELL FUNCTION IN ANKYLOSING SPONDYLITIS: THE POSSIBLE EFFECT OF TNF BLOCKAGE
    (2012) SAAD, C. G. S.; ALMEIDA, B. P. de; SOUZA, F. H. C.; MORAES, J. C. B.; NUKUMIZU, L. A.; SAMPAIO-FARROS, P. D.; VIANA, V. S. T.; BONFA, E.; SILVA, C. A.
    Introduction: Inhibin B is an important testicular Sertoli cell function marker allowing a global evaluation of testicular tissue. However there are no data regarding this cell function in ankylosing spondylitis (AS) patients.in this hormone production. Materials and Methods: 20 consecutive male AS patients and 24 healthy controls were evaluated. At study entry, AS patients were not receiving sulfasalazine/methotrexate and they never used biological/cytotoxic agents. Serum dimeric inhibin B levels were measured by a double-antibody ELISA. Demographic, disease parameters and urologic evaluation were systematically performed. The latter included testicular Döppler ultrasound, hormone profile and semen analysis. Ten of these patients received anti-TNF treatment and they were re-evaluated for inhibin B and disease parameters at 6 months(6M). Four of them also repeated sperm analysis. Results: At study entry, the median of current and spermarche age were similar in AS patients and controls [33(17-53) vs. 28.5(15-54) years, p=0.175; 13(9-18) vs. 12(11-15)years, p=0.358; respectively]. The median of inhibin B [68(23-265) vs. 112.9(47.8-231.9)pg/mL, p=0.111], FSH levels and the other hormones were comparable in both groups (p>0.05). All patients and controls had normal sperm motility and concentration with two AS patients presenting borderline low inhibin B levels. Further analysis at 6M of the 10 patients referred for anti-TNF therapy, including one with borderline inhibin B, revealed that median inhibin B levels remained largely stable [126.5(24-316) vs. 116.5(28-265)pg/mL, p=0.431]. Sperm motility/concentration were preserved in the four patients that performed this analysis after anti-TNF. Conclusions: This is the first study to demonstrate, through a specific marker, a normal testicular Sertoli cell function associated with preserved sperm quality in AS patients. We further identified that anti-TNF drugs do not seem to have a deleterious effect in inhibin B production reinforcing its safety for testicular function in this disease.
  • article 33 Citação(ões) na Scopus
    IL-23/Th17 axis is not influenced by TNF-blocking agents in ankylosing spondylitis patients
    (2016) MILANEZ, Fernanda Manente; SAAD, Carla G. S.; VIANA, Vilma T.; MORAES, Julio C. B.; PERICO, Gregory Vinicius; SAMPAIO-BARROS, Percival Degrava; GONCALVES, Celio R.; BONFA, Eloisa
    Background: Advances in pathophysiology and treatment of ankylosing spondylitis (AS) was recently demonstrated. However, the effect of anti-TNF in the newly described inflammatory pathways involved pathogenesis of this disease remains to be determined. The aim of our study was, therefore, to investigate long-term influence of anti-TNF drugs in IL-23/IL-17 axis of AS patients and their possible correlation with treatment, clinical, laboratory and radiographic parameters. Methods: Eighty-six AS anti-TNF naive patients, 47 referred for anti-TNF therapy (active-AS; BASDAI >= 4) and 39 with BASDAI < 4 (control-AS) were included. The active group was evaluated at baseline, 12-months and 24-months after TNF blockade and compared at baseline to control-AS group and to 47 healthy age-and gender-matched controls. Plasma levels of IL-17A, IL-22, IL-23 and PGE2 were measured. Non-steroidal anti-inflammatory drugs (NSAIDs) intake were recorded every 6 months. Radiographic severity and progression was assessed by mSASSS at baseline and 24 months after therapy. Results: At baseline, active-AS group presented higher IL-23 and PGE2 levels compared to control-AS group (p < 0.001 and p = 0.008) and to healthy controls (p < 0.001 and p = 0.02). After 24-months of TNF blockade, IL-23 and PGE2 remained elevated with higher levels compared with the healthy group (p < 0.001 and p = 0.03) in spite of significant improvements in all clinical/inflammatory parameters (p < 0.001). Further analysis of 27 anti-TNF-treated patients who achieved a good response (ASDAS-CRP < 2.1, with a drop >= 1.1) at 24-months revealed that IL-23 plasma levels remained higher than healthy controls (p < 0.001) and higher than control-AS group with similar disease activity (ASDAS-CRP < 2.1, p = 0.01). In active-AS group (n = 47), there was a strong correlation between IL-23 and IL-17A at baseline, 12-months and 24-months after anti-TNF therapy (p <= 0.001). Conclusion: This study provides novel data demonstrating that the IL-23/IL-17 axis is not influenced by TNF blockade in AS patients despite clinical and inflammation improvements and NSAID intake.
  • conferenceObject
    Abatacept Related Infections: No Association with Gammaglobulin Reduction.
    (2014) DINIS, Valquiria; VIANA, Vilma S. T.; LEON, Elaine P.; SILVA, Clovis A.; SAAD, Carla G. S.; MORAES, Julio C. B.; BONFA, Eloisa; RIBEIRO, Ana C. M.
  • conferenceObject
    Evidence of Serological IL-23/IL-17 Axis Activation in Ankylosing Spondylitis Patients with Long-Term TNF Blockade: The Missing Therapy Target?
    (2015) MILANEZ, Fernanda M.; SAAD, Carla G. S.; VIANA, Vilma S. T.; MORAES, Julio C. B.; PERICO, Gregory V.; GONCALVES, Celio R.; BONFA, Eloisa
  • article 3 Citação(ões) na Scopus
    Abatacept induced long-term non-progressive reduction in gamma-globulins and autoantibodies: dissociation from disease activity control
    (2020) DINIS, Valquiria G.; VIANA, Vilma T.; LEON, Elaine P.; SILVA, Clovis A.; SAAD, Carla G.; MORAES, Julio C.; BONFA, Eloisa S.; MEDEIROS-RIBEIRO, Ana C.
    Objectives To evaluate long-term effects on gamma-globulins and autoantibodies of abatacept (ABA) versus tumor necrosis factor inhibitors (TNFi) in rheumatoid arthritis (RA) patients. Method Eighteen RA patients undergoing abatacept (ABA-RA) and 18 age/sex-matched patients treated with TNFi (TNFi-RA) were compared regarding clinical data, total gamma-globulins (TGG), specific subtypes (IgG, IgM, IgA), free light chains (FLC), IgM/IgG rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP3), and anti-mutated citrullinated vimentin (anti-MCV), assessed before and every 6 months, up to 24 months. Exclusion criteria: previous abatacept/rituximab or low TGG (< 0.7 g/dL). Results At baseline, female sex (78 vs. 78%), age (55 vs. 53 years), DAS28 (5.73 vs. 5.67), TGG (1.4 vs. 1.35 g/dL), IgG (1168 vs. 1079 mg/dL), IgM (107 vs. 113 mg/dL), IgA (333 vs. 322 mg/dL), kappa (342 vs. 249 mg/dL), lambda (170 vs. 150 mg/dL), IgM-RF (76 vs. 53 UI), IgG-RF (63 vs. 25 UI), anti-CCP3 (216 vs. 189 UI), and anti-MCV (202 vs. 102 UI) were comparable in ABA-RA and TNFi-RA (p > 0.05). Similar disease activity improvement was observed in both groups. In ABA-RA, significant decreases (p < 0.05) were observed in TGG (1.4 vs. 1.05 g/dL), IgG (1168 vs. 997), IgA (333 vs. 278 mg/dL), kappa (342 vs. 257 mg/dL), lambda (170 vs. 144 mg/dL), IgM-RF (76 vs. 37 UI), IgG-RF (65 vs. 24 UI), anti-CCP3 (216 vs. 183 UI), and anti-MCV (202 vs. 60 UI) at 6 months, without further decreases. In contrast, TNFi-RA showed no decrease in any of such parameters. ABA-RA also had more often transient IgG levels under the lower limit of normality (66.7% vs. 33.3%, p = 0.046). No severe infection occurred. DAS28, ESR, and CRP correlated significantly to gamma-globulins and FLC at baseline (p < 0.05), but these correlations were longitudinally lost in ABA-RA, but not in TNFi-RA. Conclusion ABA, but not TNFi, induces a safe, persistent, long-term, and non-progressive reduction in gamma-globulins and autoantibodies, including anti-MCV. This pattern is dissociated from disease activity control.
  • article 62 Citação(ões) na Scopus
    Glucocorticoid: Major Factor for Reduced Immunogenicity of 2009 Influenza A (H1N1) Vaccine in Patients with Juvenile Autoimmune Rheumatic Disease
    (2012) AIKAWA, Nadia E.; CAMPOS, Lucia M. A.; SILVA, Clovis A.; CARVALHO, Jozelio F.; SAAD, Carla G. S.; TRUDES, Guilherme; DUARTE, Alberto; MIRAGLIA, Joao L.; TIMENETSKY, Maria do Carmo S.; VIANA, Vilma S. T.; FRANCA, Ivan L. A.; BONFA, Eloisa; PEREIRA, Rosa M. R.
    Objective. To assess the immunogenicity and safety of non-adjuvanted influenza A H1N1/2009 vaccine in patients with juvenile autoimmune rheumatic disease (ARD) and healthy controls, because data are limited to the adult rheumatologic population. Method's. A total of 237 patients with juvenile ARD [juvenile systemic lupus erythematosus (JSLE), juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM), juvenile scleroderma, and vasculitis] and 91 healthy controls were vaccinated. Serology for anti-H1N1 was performed by hemagglutination inhibition assay. Seroprotection rate, seroconversion rate, and factor-increase in geometric mean titer (GMT) were calculated. Adverse events were evaluated. Results. Age was comparable in patients and controls (14.8 +/- 3.0 vs 14.6 +/- 3.7 years, respectively; p = 0.47). Three weeks after immunization, seroprotection rate (81.4% vs 95.6%; p = 0.0007), seroconversion rate (74.3 vs 95.6%; p < 0.0001), and the factor-increase in GMT (12.9 vs 20.3; p = 0.012) were significantly lower in patients with juvenile ARD versus controls. Subgroup analysis revealed reduced seroconversion rates in JSLE (p < 0.0001), JIA (p = 0.008), JDM (p = 0.025), and vasculitis (p = 0.017). Seroprotection (p < 0.0001) and GMT (p < 0.0001) were decreased only in JSLE. Glucocorticoid use and lymphopenia were associated with lower seroconversion rates (60.4 vs 82.9%; p = 0.0001; and 55.6 vs 77.2%; p = 0.012). Multivariate logistic regression including diseases, lymphopenia, glucocorticoid, and immunosuppressants demonstrated that only glucocorticoid use (p = 0.012) remained significant. Conclusion. This is the largest study to demonstrate a reduced but adequate immune response to H1N1 vaccine in patients with juvenile ARD. It identified current glucocorticoid use as the major factor for decreased antibody production. The short-term safety results support its routine recommendation for patients with juvenile ARD.
  • conferenceObject
    IN VIVO EVIDENCE OF IL-17/IL-23 AXIS ACTIVATION IN ANKYLOSING SPONDYLITIS PATIENTS WITH LONG-TERM TNF BLOCKADE: THE MISSING THERAPY TARGET?
    (2015) MILANEZ, F. M.; SAAD, C. G.; VIANA, V. T.; MORAES, J. C.; PERICO, G. V.; SILVA, C. A.; GONCALVES, C. R.; BONFA, E.
  • article 21 Citação(ões) na Scopus
    Testicular Sertoli cell function in ankylosing spondylitis
    (2013) ALMEIDA, Breno Pires; SAAD, Carla Goncalves Schahin; SOUZA, Fernando Henrique Carlos; MORAES, Julio Cesar Bertacini; NUKUMIZU, Lucia Akemi; VIANA, Vilma Santos Trindade; BONFA, Eloisa; SILVA, Clovis Artur
    To assess the testicular Sertoli cell function according to inhibin B levels in ankylosing spondylitis (AS) patients and the possible effect of anti-TNF therapy on this hormone production, 20 consecutive AS patients and 24 healthy controls were evaluated. At study entry, AS patients were not receiving sulfasalazine/methotrexate and never have used biological/cytotoxic agents. They were assessed by serum inhibin B levels, hormone profile, urological examination, testicular ultrasound, seminal parameters, and clinical features. Ten of these patients received anti-TNF treatment and they were reevaluated for Sertoli function and disease parameters at 6 months. Four of them agreed to repeat sperm analysis. At study entry, the median of inhibin B (68 vs. 112.9 pg/mL, p = 0.111), follicle-stimulating hormone levels (3.45 vs. 3.65 IU/L, p = 0.795), and the other hormones was comparable in AS patients and controls (p > 0.05). Sperm analysis was similar in AS patients and controls (p > 0.05) with one AS patient presenting borderline low inhibin B levels. Further analysis at 6 months of the 10 patients referred for anti-TNF therapy, including one with borderline inhibin B, revealed that median inhibin B levels remained stable (116.5 vs. 126.5 pg/mL, p = 0.431) with a significant improvement in C-reactive protein (27.8 vs. 2.27 mg/L, p = 0.039). Sperm motility and concentration were preserved in the four patients who repeated this analysis after TNF blockage. In conclusion, this was the first study to report, using a specific marker, a normal testicular Sertoli cell function in AS patients with mild to moderate disease activity.
  • article 6 Citação(ões) na Scopus
    Anti-alpha-enolase antibodies in Behcet's disease: a marker of mucocutaneous and articular disease activity?
    (2018) PRADO, L. L.; GONCALVES, C. R.; VIANA, V. T.; SAAD, C. G. S.; BONFA, E.
    Objective. To assess IgM anti-alphaenolase antibodies (AAEA) in systemic Behget's disease (BD) and its possible association with clinical manifestations and disease activity. Methods. Ninety-seven consecutively selected BD patients were compared to 36 enteropathic spondyloarthritis (ESpA) [24 Crohn's disease (CD) and 12 ulcerative colitis (UC)] patients and 87 healthy controls. 1gM AAEA was detected by immunoblotting. Disease activity was assessed by standardised indexes, Brazilian BD Current Activity Form (BR-BDCAF) for BD and HarveyBradshaw Index (HBI) for CD and UC patients. A second evaluation was performed in BD patients (n=56), regarding IgM AAEA presence, disease activity scores and C-reactive protein (CRP). Results. Higher IgM AAEA prevalence was found in 97 BD (17.7%) compared to ESpA (2.8%) and healthy controls (2.3%), p< O. O01. IgM AAEA frequency was higher in active BD compared to inactive BD (30.2% vs. 7.4%, p=O. O06), a finding confirmed in the second cross-sectional evaluation of 56 of these BD patients (45.5% vs. 13.3%, p=O. 02). Mean BR-BDCAF scores were higher in IgM AAEA positive group on both evaluations (9.1 + 5.4 vs. 4.9 + 4.9, p=O. O02; 5.0 + 4.9 vs. 2.2 + 2.9, p=O. 01, respectively). BD patients with mucocutaneous and articular symptoms presented higher IgM AAEA positivity in the first and second evaluations (64.7% vs. 27.5%, p=O. O05; 36.4% vs. 7.1%, p=0.039 respectively). Conclusions. Our data support the notion that alpha-enolase is a target antigen in BD, particularly associated with disease activity, mucocutaneous and articular involvement. In addition, IgM AAEA may distinguish BD from ESpA, especially in patients with high disease activity.