NATALIA SOUSA FREITAS QUEIROZ
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- Long-term real life efficacy of infliximab in Crohn's disease: Brazilian initial experience since 1999(2019) ARCEU, Scanavini Neto; NATALIA, Queiroz; MARCELO, Borba; CARLOS, Sobrado; MAGALY, Teixeira; EDESIO, Silva-Fillho; SERGIO, Nahas; IVAN, Cecconello
- Long-term effectiveness and safety of ustekinumab in bio-naive and bio-experienced anti-tumor necrosis factor patients with Crohn's disease: a real-world multicenter Brazilian study(2022) PARRA, Rogerio Serafim; CHEBLI, Julio Maria Fonseca; QUEIROZ, Natalia Sousa Freitas; DAMIAO, Aderson Omar Mourao Cintra; AZEVEDO, Matheus Freitas Cardoso de; CHEBLI, Liliana Andrade; BERTGES, Erika Ruback; ALVES JUNIOR, Antonio Jose Tiburcio; AMBROGINI JUNIOR, Orlando; SILVA, Bianca Loyo Pona Schiavetti da; LUBINI, Marcio; BAFUTTO, Mauro; FLORES, Cristina; VILELA, Eduardo Garcia; BORATTO, Sandra Felice; GASPARETTI JUNIOR, Newton Luiz Tricarico; STEINWURZ, Flavio; CARVALHO, Nayara Salgado; FERES, Omar; ROCHA, Jose Joaquim Ribeiro daBackground The effectiveness of ustekinumab (UST) in the treatment of Crohn's disease (CD) has been demonstrated in the pivotal Phase 3 UNITI 1 and 2 and IM-UNITI studies in both anti-TNF-naive and anti-TNF-exposed patients. Given the selective nature of pivotal trial designs, real-world effectiveness and safety studies are warranted. We report our experience with UST treatment in a large, real-world multicenter cohort of Brazilian patients with CD. Methods We performed a retrospective multicenter study including patients with CD, predominantly biologically refractory CD, who received UST. The primary endpoint was the proportion of patients in clinical remission at weeks 8, 24 and 56. Possible predictors of clinical and biological response/remission and safety outcomes were also assessed. Results Overall, 245 CD (mean age 39.9 [15-87]) patients were enrolled. Most patients (86.5%) had been previously exposed to biologics. According to nonresponder imputation analysis, the proportions of patients in clinical remission at weeks 8, 24 and 56 were 41.0% (n = 98/239), 64.0% (n = 153/239) and 39.3% (n = 94/239), respectively. A biological response was achieved in 55.4% of patients at week 8, and 59.3% were in steroid-free remission at the end of follow-up. No significant differences in either clinical or biological remission were noted between bio-naive and bio-experienced patients. Forty-eight patients (19.6%) presented 60 adverse events during the follow-up, of which 8 (13.3%) were considered serious adverse events (3.2% of 245 patients). Overall, a proximal disease location, younger age, perianal involvement, and smoking were associated with lower rates of clinical remission over time. Conclusions UST therapy was effective and safe in the long term in this large real-life cohort of Brazilian patients with refractory CD, regardless of previous exposure to other biological agents.
- Safety of anti-TNF introduction following tuberculosis treatment in Inflammatory Bowel Disease patients in an endemic area(2021) AZEVEDO, M. F. C. D.; JUSTUS, F. F.; LIMA, C. C. G.; GARCIA, K. S.; BARROS, L. L.; OBA, J.; CARLOS, A. D. S.; MILANI, L. R.; SIPAHI, A. M.; DAMIAO, A. O. M. C.; QUEIROZ, N. S. F.
- Coexistence of Takayasu's Arteritis in Patients with Inflammatory Bowel Diseases(2021) MARTINS, Camilla de Almeida; CAON, Ana Elisa Rabe; FACANALI, Carolina Bortolozzo Graciolli; SOBRADO, Carlos Walter; NAHAS, Sergio Carlos; PEREIRA, Rosa Maria Rodrigues; MARGALIT-YEHUDA, Reuma; KOPYLOV, Uri; QUEIROZ, Natalia Sousa FreitasBackground. Takayasu's arteritis (TA) and inflammatory bowel disease (IBD) are chronic inflammatory granulomatous disorders that have rarely been concomitantly reported in case reports and small case series. Objective. We report a series of seven cases of TA and IBD association in two referral centers with a comprehensive review of literature. Methods. We analyzed retrospectively the electronic medical charts of TA-IBD patients at the University Hospital of Sao Paulo, Brazil, and at the Sheba Medical Center at Tel Aviv University, Israel. Results. Overall, five patients had Crohn's disease (DC) and two had ulcerative colitis (UC), and they were mostly female and non-Asian. All patients developed IBD first and, subsequently, TA. Two underwent colectomy and one ileocecectomy due to IBD activity, while three required cardiovascular surgery due to TA activity. Most patients are currently in clinical remission of both diseases with conventional drug treatment. Conclusion. Although the coexistence of TA and IBD is uncommon, both seem to be strongly associated through pathophysiological pathways.
- Peroral endoscopic myotomy (POEM): a comparative study between Chagasic and idiopathic achalasia(2020) FARIAS, Galileu F. A.; MOURA, Diogo T. H. de; MOURA, Eduardo T. H. de; REZENDE, Daniel T. de; HATHORN, Kelly E.; NASI, Ary; QUEIROZ, Natalia S. F.; MOURA, Eduardo G. H. deBackground and study aims Achalasia can be classified as either primary (idiopathic) achalasia or secondary achalasia, which is a consequence of another systemic disease. Peroral endoscopic myotomy (POEM) is an effective and safe treatment for achalasia. We evaluated the efficacy and safety of POEM in patients with Chagasic achalasia compared to idiopathic achalasia. Patients and methods We evaluated POEM procedures performed at a single institution from November 2016 to January 2018. Demographic data, Eckardt score, lower esophageal sphincter (LES) pressure, body mass index, post-operative erosive esophagitis, adverse events, length of hospital stay, and procedure-related parameters were analyzed. Results Fifty-one patients underwent POEM as a treatment for achalasia in this period (20 patients with Chagasic and 31 with Idiopathic etiology). The overall clinical success rate was 92.1 %, with no statistical difference between groups (90 % in the Chagasic group vs. 93.5 % in the Idiopathic group, P = 0.640). Both groups had significant reduction in Eckardt score and in LES pressure, and increase in bodey mass index (BMI) at 1-year follow-up. There was no statistical difference between groups regarding Eckardt score ( P = 0.439), LES pressure (p = 0.507), BMI ( P = 0.254), post erosive esophagitis (35 % vs. 38.7 %, P = 0.789), adverse events (30 % vs. 12 %, P = 0.163,) length of hospital stay (3.75 days vs. 3.58 days, P = 0.622), and operative time (101.3 min vs. 99.1 min, P = 0.840). Conclusion POEM is an effective and safe treatment for patients with achalasia. There is no difference in POEM outcomes for those patients with Chagasic or Idiopathic achalasia.
- A higher prevalence of human papillomavirus in patients with perianal fistulizing Crohn's disease compared to patients with anorectal fistula without Crohn's disease(2021) BOARINI, L. Rodrigues; SOBRADO JR., C. W.; FACANALI, C. B. G.; QUEIROZ, N. S. F.; ALBUQUERQUE, I. C.; BOARINI, P.; BOARINI, M. R.; BORBA, M. R.; NAHAS, S. C.; CECCONELLO, I.
- Abnormal esophageal motility during a solid test meal in systemic sclerosis-detection even in very early disease and association with disease progression(2019) BUTIKOFER, Simon; JORDAN, Suzana; SAUTER, Matthias; HOLLENSTEIN, Michael; HEINRICH, Henriette; FREITAS-QUEIROZ, Natalia; KUNTZEN, Thomas; ANG, Daphne; OBERACHER, Marcos; MAURER, Britta; SCHWIZER, Werner; FOX, Mark; DISTLER, Oliver; MISSELWITZ, BenjaminObjective This study assessed whether high-resolution manometry (HRM) with a test meal can detect clinically relevant, abnormal motility already in very early systemic sclerosis (SSc) and whether this finding is associated with subsequent disease progression. Methods This prospective, longitudinal cohort study recruited 68 consecutive SSc patients (group #1: 32 established disease (ACR, American College of Rheumatology /EULAR, The European League against Rheumatism 2013 and ACR 1980 criteria fulfilled); group #2: 24 early disease (only ACR/EULAR 2013 fulfilled); group #3: 12 very early disease (clinical expert diagnosis of SSc) and 72 healthy controls. HRM evaluated esophageal motility for water swallows and a solid test meal. Results Systemic sclerosis patients had less frequent effective esophageal contractions during the test meal compared to healthy controls even in very early disease (0.15, 1.0, 2.1 per minute for groups #1, #2, and #3, vs 2.5 per minute in health; P < 0.001, P < 0.001, and P < 0.0085, respectively). Ineffective motility at HRM was associated with a higher modified Rodnan skin score at baseline. Moreover, at mean 18 (10-31) months of follow-up, the presence of ineffective motility at baseline was associated with progression of skin disease (P = 0.01). Cox proportional hazard regression analysis identified hypotensive peristalsis in the test meal (<15% effective solid swallows) and low distal contractile integral (DCI; <400 mm Hg.cms) as predictors for skin aggravation, but not for new organ involvement. Conclusion Ineffective motility during a test meal is present already in patients with very early SSc. Findings on HRM studies are associated with disease severity at baseline, and low percentage of effective swallows in test meal and low mean DCI are both predictors of skin progression during follow-up.
conferenceObject High resolution manometry parameters to assess barrier function of the gastro-esophageal junction and to identify patients with gastro-esophageal reflux disease: a case-control study(2016) FREITAS-QUEIROZ, N.; JASPER, D.; HOLLENSTEIN, M.; MISSELWITZ, B.; LAYER, P.; NAVARRO-RODRIGUEZ, T.; FOX, M.; KELLER, J.- Safety considerations with biologics and new inflammatory bowel disease therapies(2020) QUEIROZ, Natalia S. F.; REGUEIRO, MiguelPurpose of review The safety profile of therapies is an important issue that should always be shared with patients when choosing their treatment. The introduction of biologics over the past 2 decades represented a breakthrough in the management of inflammatory bowel diseases (IBDs). With better understanding of the pathophysiology of the disease, emerging therapies targeting different mechanisms of action have been developed including targeted monoclonal antibodies and small molecules. However, increasing concerns about the safety and side effects of these drugs have been challenging clinicians in clinical practice. Recent findings Comparative safety data between different therapies are lacking in the literature. Most safety recommendations are based on adverse events reported in clinical trials and register-based cohorts. An extensive literature review addressing the risk of infections, malignancies, immunogenicity, and metabolic disorders was performed for biologics and new IBD therapies based on reported adverse events in pivotal trials, long-term extension trials and real-world studies. In this article, we summarize the most recent data on safety of biologics and new IBD therapies and propose hierarchical positioning of drugs regarding safety based on expert opinion recommendations.
- What is the Real Impact of Corticosteroids in the Contemporary Treatment of Crohn's Disease?(2022) UEMURA, Karime Lucas; QUEIROZ, Natalia Sousa Freitas; LEES, Charlie W.