IEDA MARIA MAGALHAES LAURINDO

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

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  • article 92 Citação(ões) na Scopus
    Abatacept and Reduced Immune Response to Pandemic 2009 Influenza A/H1N1 Vaccination in Patients With Rheumatoid Arthritis
    (2013) RIBEIRO, Ana C.; LAURINDO, Ieda M.; GUEDES, Lissiane K.; SAAD, Carla G.; MORAES, Julio C.; SILVA, Clovis A.; BONFA, Eloisa
    Objective. To evaluate the influence of abatacept (ABA) and associated contributing factors on pandemic 2009 influenza A/H1N1 vaccine immunogenicity in rheumatoid arthritis (RA) patients. Methods. The response to a nonadjuvanted monovalent pandemic 2009 influenza A/H1N1 killed virus vaccine was analyzed in 11 RA patients using ABA (RA-ABA), most with concomitant nonbiologic disease-modifying antirheumatic drugs (DMARDS), and compared to 33 age-matched RA patients on methotrexate (MTX) and 55 healthy controls, all without previous seroprotection. Clinical and laboratory evaluations were performed before and 21 days after vaccination. Anti-influenza antibody titers were measured by hemagglutination inhibition assay. Seroprotection (antibody titers >= 1:40) and the factor increase (FI) in the geometric mean titers (GMTs) were calculated. Prevaccination lymphocyte counts and gammaglobulin levels were determined. Results. Sex distribution, disease duration, and the Disease Activity Score in 28 joints were similar in the RA groups (P > 0.05). After vaccination, seroprotection was significantly reduced in RA-ABA patients compared to RA-MTX patients (9% versus 58%; P = 0.006) and controls (69%; P <= 0.001). FI-GMT was severely reduced in RA-ABA patients compared to RA-MTX patients (1.8 [1.4-2.3] versus 8.7 [5.2-17.4]; P < 0.001) and controls (11.5 [8.0-16.7]; P <= 0.001). Lymphocyte counts were comparable in RA groups (P > 0.05), but RA-ABA patients had slightly lower gammaglobulin levels than RA-MTX patients (0.9 gm/dl [0.6-1.8] versus 1.2 gm/dl [0.8-1.7]; P = 0.03), although almost all were within the normal range values. Conclusion. The current study established that ABA, in association with traditional DMARDs, significantly reduces the humoral response to pandemic 2009 influenza A/H1N1 vaccine in RA patients. The results suggest an influence of costimulatory modulation in humoral response to this vaccine.
  • article 24 Citação(ões) na Scopus
    LTBI screening in rheumatoid arthritis patients prior to anti-TNF treatment in an endemic area
    (2014) BONFIGLIOLI, K. R.; RIBEIRO, A. C. M.; MORAES, J. C. B.; SAAD, C. G. S.; SOUZA, F. H. C.; CALICH, A. L.; BONFA, E.; LAURINDO, I. M. M.
    SETTING: Recommendations for screening for latent tuberculous infection (LTBI) in patients eligible for antitumour necrosis factor (TNF) agents remain unclear in endemic regions. OBJECTIVE: To evaluate the long-term efficacy of LTBI screening and treatment in patients with rheumatoid arthritis (RA) receiving TNF blockers. DESIGN: A total of 202 RA patients were screened for LTBI before receiving anti-TNF treatment Using the tuberculin skin test (TST), chest X-ray (CXR) and history of exposure to tuberculosis (TB). All subjects were regularly followed at 1- to 3-month intervals. RESULTS: Eighty-five patients (42%) were treated with a single anti-TNF agent, while 117 patients (58%) changed anti-TNF agents once or twice. LTBI screening was positive in 66 patients, 44 were TST-positive, 23 had a history of TB exposure and 14 had an abnormal CXR. Exposure alone accounted for LTBI diagnosis in 14 patients with a negative TST. LTBI patients were treated with isoniazid (300 mg/day) for 6 months, and none developed TB. During follow-up, TST was repeated in 51 patients. Conversion was observed in 5; 3 were diagnosed with LTBI and 2 with active TB respectively 14 and 36 months after receiving anti-TNF treatment, suggesting new TB exposure. CONCLUSION: LTBI screening and treatment before anti-TNF treatment is effective in endemic areas and reinforces the importance of establishing contact history for diagnosing LTBI in RA patients.
  • article 77 Citação(ões) na Scopus
    Reduced seroprotection after pandemic H1N1 influenza adjuvant-free vaccination in patients with rheumatoid arthritis: implications for clinical practice
    (2011) RIBEIRO, Ana C. M.; GUEDES, Lissiane K. N.; MORAES, Julio C. B.; SAAD, Carla G. S.; AIKAWA, Nadia E.; CALICH, Ana Luisa; FRANCA, Ivan L. A.; CARVALHO, Jozelio F.; SAMPAIO-BARROS, Percival D.; GONCALVES, Celio R.; BORBA, Eduardo F.; TIMENETSKY, Maria do Carmo S.; PRECIOSO, Alexander R.; DUARTE, Alberto; BONFA, Eloisa; LAURINDO, Ieda M. M.
    Background Reduced response to pandemic (2009) H1N1 (pH1N1) vaccine in patients with rheumatoid arthritis (RA) was recently reported. Objectives To evaluate the contribution of age, disease activity, medication and previous antibody levels to this reduced response. Methods 340 adult RA patients and 234 healthy controls were assessed before and 21 days after adjuvant-free influenza A/California/7/2009 (pH1N1) vaccine. Disease activity (DAS28), current treatment and pH1N1 antibody titres were collected. Seroprotection, seroconversion and factor increase in geometric mean titre (GMT) were calculated and adverse events registered. Results RA and controls showed similar (p> 0.05) prevaccination GMT (8.0 vs 9.3) and seroprotection (10.8% vs 11.5%). After vaccination a significant reduction (p< 0.001) was observed in all endpoints: GMT and factor increase in GMT, seroprotection and seroconversion rates. Disease activity did not preclude seroconversion or seroprotection and remained unchanged in 97.4% of patients. Methotrexate was the only disease-modifying antirheumatic drug associated with reduced responses (p= 0.001). Vaccination was well tolerated. Conclusions The data confirmed both short-term anti-pH1N1 vaccine safety and, different from most studies with seasonal influenza, reduced seroprotection in RA patients, unrelated to disease activity and to most medications (except methotrexate). Extrapolation of immune responses from one vaccine to another may therefore not be possible and specific immunisation strategies (possibly booster) may be needed.
  • article 0 Citação(ões) na Scopus
    LTBI screening in rheumatoid arthritis patients prior to anti-TNF treatment in an endemic area (vol 18, pg 905, 2014)
    (2014) BONFIGLIOLI, K. R.; RIBEIRO, A. C. M.; MORAES, J. C. B.; SAAD, C. G. S.; SOUZA, F. H. C.; CALICH, A. L.; BONFA, E.; LAURINDO, I. M. M.
  • article 60 Citação(ões) na Scopus
    TNF blockers show distinct patterns of immune response to the pandemic influenza A H1N1 vaccine in inflammatory arthritis patients
    (2012) FRANCA, Ivan Leonardo Avelino; RIBEIRO, Ana Cristina Medeiros; AIKAWA, Nadia Emi; SAAD, Carla Goncalves Schain; MORAES, Julio Cesar Bertacine; GOLDSTEIN-SCHAINBERG, Claudia; LAURINDO, Ieda Maria Magalhaes; PRECIOSO, Alexander Roberto; ISHIDA, Maria Akiko; SARTORI, Ana Marli Christovam; SILVA, Clovis Artur; BONFA, Eloisa
    Methods. One hundred and twenty patients (RA, n = 41; AS, n = 57; PsA, n = 22) on anti-TNF agents (monoclonal, n = 94; soluble receptor, n = 26) were compared with 116 inflammatory arthritis patients under DMARDs and 117 healthy controls. Seroprotection, seroconversion (SC), geometric mean titre, factor increase in geometric mean titre and adverse events were evaluated 21 days after vaccination. Results. After immunization, SC rates (58.2% vs 74.3%, P = 0.017) were significantly lower in SpA patients receiving anti-TNF therapy, whereas no difference was observed in RA patients receiving this therapy compared with healthy controls (P = 0.067). SpA patients receiving mAbs (infliximab/adalimumab) had a significantly lower SC rate compared with healthy controls (51.6% vs 74.3%, P = 0.002) or those on DMARDs (51.6% vs 74.7%, P = 0.005), whereas no difference was observed for patients on etanercept (86.7% vs 74.3%, P = 0.091). Further analysis of non-seroconverting and seroconverting SpA patients revealed that the former group had a higher mean age (P = 0.003), a higher frequency of anti-TNF (P = 0.031) and mAbs (P = 0.001) and a lower frequency of MTX (P = 0.028). In multivariate logistic regression, only older age (P = 0.015) and mAb treatment (P = 0.023) remained significant factors for non-SC in SpA patients. Conclusion. This study revealed a distinct disease pattern of immune response to the pandemic influenza vaccine in inflammatory arthritis patients receiving anti-TNF agents, illustrated by a reduced immunogenicity solely in SpA patients using mAbs. Trial Registration: ClinicalTrials.gov, ext-link-type=""uri"" xlink:href=""www.clinicaltrials.gov"" xmlns:xlink=""http://www.w3.org/1999/xlink"">www.clinicaltrials.gov, NCT01151644.