LUCIANA PARENTE COSTA SEGURO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
2 resultados
Resultados de Busca
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- Influenza A/H1N1 vaccination of patients with SLE: can antimalarial drugs restore diminished response under immunosuppressive therapy?(2012) BORBA, Eduardo F.; SAAD, Carla G. S.; PASOTO, Sandra G.; CALICH, Ana L. G.; AIKAWA, Nadia E.; RIBEIRO, Ana C. M.; MORAES, Julio C. B.; LEON, Elaine P.; COSTA, Luciana P.; GUEDES, Lissiane K. N.; SILVA, Clovis A. A.; GONCALVES, Celio R.; FULLER, Ricardo; OLIVEIRA, Suzimara A.; ISHIDA, Maria A.; PRECIOSO, Alexander R.; BONFA, EloisaObjective. To assess the efficacy and safety of pandemic 2009 influenza A (H1N1) in SLE under different therapeutic regimens. Methods. A total of 555 SLE patients and 170 healthy controls were vaccinated with a single dose of a non-adjuvanted preparation. According to current therapy, patients were initially classified as SLE No Therapy (n = 75) and SLE with Therapy (n = 480). Subsequent evaluations included groups under monotherapy: chloroquine (CQ) (n = 105), prednisone (PRED) epsilon 20 mg (n = 76), immunosuppressor (IS) (n = 95) and those with a combination of these drugs. Anti-H1N1 titres and seroconversion (SC) rate were evaluated at entry and 21 days post-vaccination. Results. The SLE with Therapy group had lower SC compared with healthy controls (59.0 vs 80.0%; P < 0.0001), whereas the SLE No Therapy group had equivalent SC (72 vs 80.0%; P = 0.18) compared with healthy controls. Further comparison revealed that the SC of SLE No Therapy (72%) was similar to the CQ group (69.5%; P = 0.75), but it was significantly reduced in PRED epsilon 20 mg (53.9%; P = 0.028), IS (55.7%; P = 0.035) and PRED epsilon 20 mg + IS (45.4%; P = 0.038). The concomitant use of CQ in each of these later regimens was associated with SC responses comparable with SLE No Therapy group (72%): PRED epsilon 20 mg + CQ (71.4%; P = 1.00), IS + CQ (65.2%; P = 0.54) and PRED epsilon 20 mg + IS + CQ (57.4%; P = 0.09). Conclusion. Pandemic influenza A H1N1/2009 vaccine response is diminished in SLE under immunosuppressive therapy and antimalarials seems to restore this immunogenicity.
conferenceObject IS H1N1 INFLUENZA VACCINE SAFE AND EFFECTIVE IN PATIENTS WITH SSc?(2012) ANDRADE, D.; SEGURO, L.; RIBEIRO, A.; MORAES, J.; SAAD, C.; AIKAWA, N.; CALICH, A.; VIANA, V.; PASOTO, S.; LEVY-NETO, M.; LAURINDO, I.; TIMENESTSKY, M.; PRECIOSO, A.; BONFA, E.; SAMPAIO-BARROS, P.Introduction. Immunosuppressed patients are potentially at risk to suffer from life-threatening pulmonary infections caused by H1N1. Although pulmonary disease is an important cause of morbidity in patients with SSc, low rates of influenza vaccination are still observed in this population due to lack of information and fear of adverse events. The recent WHO recommendation that the 2010–2011 trivalent seasonal flu vaccine must contain A/California/7/2009/H1N1-like virus reinforces the need to access the safety and efficacy of H1N1 vaccination in SSc patients. Patients and methods. One hundred twenty-seven patients and 234 controls were vaccinated with adjuvant-free influenza A/California/7/2009 (pH1N1) vaccine. All participants were evaluated pre- and 21 days post-vaccination and serology for anti-H1N1 was performed by haemagglutination inhibition (HI) assay (HIA). Efficacy was assessed by seroprotection and seroconversion rates and the factor increase in geometric mean antibody titre (GMT). Participants received a 21-day symptom diary card and were instructed to report local and systemic adverse events. Severe side effects were considered if hospitalization was required. Results. SSc patients had mean age of 52 (5.3) years, mean disease duration of 11.96 (7.9) years and a female predominance (93%). Of SSc patients, 69.3% had limited cutaneous disease, whereas 30.7% had diffuse cutaneous disease. Half of the patients were on immunosuppressant therapy (mostly AZA, MTX and CYC). Thirteen (10%) patients were taking CSs, but only two patients received a daily dose > 10 mg of prednisone. SSc patients and controls presented similar pre-vaccination GMT (11.2 vs 9.3; P = 0.094) and seroprotection rates (18.1 vs. 11.5%; P = 0.110). After vaccination seroprotection rates (81.1 vs 82.9%; P = 0.668) and GMT (134.4 vs. 122.9; P = 0.654) rose in both groups. Seroconversion rates (72.4 vs 76.9%; P = 0.372) and factor increase in GMT (12.0 vs 13.2; P = 0.553) were comparable in both groups. Disease-modifying antirheumatic drugs were not associated with reduced vaccination responses (P > 0.05). Immunization was well tolerated with mild local (7.1 vs 14.1%; P = 0.058) and minor systemic reactions (23.6 vs 25.6%; P = 0.704) in patients and controls, respectively. No severe side effect was reported.Conclusion. Vaccination against H1N1 was safe and induced a satisfactory response in patients with SSc, including in those under immunosuppressive therapy. Due to the inherent risks of lower respiratory infections in this group of patients, physicians should consider annually influenza vaccination recommendation.