ANA CRISTINA DE MEDEIROS RIBEIRO

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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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  • conferenceObject
    Behcet's Disease Activity: An Important Factor For Immunogenicity Of Unadjuvanted Influenza A/H1N1 Vaccine
    (2013) PRADO, Leandro L.; SAAD, Carla G. S.; MORAES, Julio C. B.; RIBEIRO, Ana Cristina Medeiros; AIKAWA, Nadia E.; SILVA, Clovis A.; SCHAINBERG, Claudia G.; SAMPAIO-BARROS, Percival D.; PRECIOSO, Alexander R.; ISHIDA, Maria A.; BONFA, Eloisa; GONCALVES, Celio
  • conferenceObject
    Immunogenicity and Safety of an Inactivated Virus Vaccine Against SARS-CoV-2 in Patients with Autoimmune Rheumatic Diseases
    (2021) MEDEIROS-RIBEIRO, Ana; AIKAWA, Nadia; SAAD, Carla Goncalves Schahin; YUKI, Emily Figueiredo Vieira Neves; PEDROSA, Tatiana do Nascimento; FUSCO, Solange; ROJO, Priscila; PEREIRA, Rosa; SHINJO, Samuel; ANDRADE, Danieli; SAMPAIO-BARROS, Percival; RIBEIRO, Carolina; DEVEZA, Giordano; MARTINS, Victor Adriano de Oliveira; SILVA, Clovis Artur; LOPES, Marta; DUARTE, Alberto; ANTONANGELO, Leila; SABINO, Ester; KALLAS, Esper; PASOTO, Sandra Gofinet; BONFA, Eloisa
  • article 4 Citação(ões) na Scopus
    Immunogenicity and safety of primary fractional-dose yellow fever vaccine in autoimmune rheumatic diseases
    (2021) TONACIO, Adriana Coracini; PEDROSA, Tatiana do Nascimento; BORBA, Eduardo Ferreira; AIKAWA, Nadia Emi; PASOTO, Sandra Gofinet; FERREIRA FILHO, Julio Cesar Rente; BARROS, Marilia Mantovani Sampaio; LEON, Elaine Pires; LOMBARDI, Suzete Cleusa Ferreira Spina; MENDRONE JUNIOR, Alfredo; AZEVEDO, Adriana de Souza; SCHWARCZ, Waleska Dias; FULLER, Ricardo; YUKI, Emily Figueiredo Neves; LOPES, Michelle Remiao Ugolini; PEREIRA, Rosa Maria Rodrigues; BARROS, Percival Degrava Sampaio; ANDRADE, Danieli Castro Oliveira de; MEDEIROS-RIBEIRO, Ana Cristina de; MORAES, Julio Cesar Bertacini de; SHINJO, Samuel Katsuyuki; MIOSSI, Renata; DUARTE, Alberto Jose da Silva; LOPES, Marta Heloisa; KALLAS, Esper Georges; SILVA, Clovis Artur Almeida da; BONFA, Eloisa
    Background Brazil faced a yellow fever(YF) outbreak in 2016-2018 and vaccination was considered for autoimmune rheumatic disease patients(ARD) with low immunosuppression due to YF high mortality. Objective This study aimed to evaluate, prospectively for the first time, the short-term immunogenicity of the fractional YF vaccine(YFV) immunization in ARD patients with low immunossupression. Methods and Results A total of 318 participants(159 ARD and 159 age- and sex-matched healthy controls) were vaccinated with the fractional-dose(one fifth) of 17DD-YFV. All subjects were evaluated at entry(D0), D5, D10, and D30 post-vaccination for clinical/laboratory and disease activity parameters for ARD patients. Post-vaccination seroconversion rate(83.7%vs.96.6%, p = 0.0006) and geometric mean titers(GMT) of neutralizing antibodies[1143.7 (95%CI 1012.3-1292.2) vs.731 (95%CI 593.6-900.2), p< 0.001] were significantly lower in ARD compared to controls. A lower positivity rate of viremia was also identified for ARD patients compared to controls at D5 (53%vs.70%, p = 0.005) and the levels persisted in D10 for patients and reduced for controls(51%vs.19%, p = 0.0001). The viremia was the only variable associated with seroconvertion. No serious adverse events were reported. ARD disease activity parameters remained stable at D30(p>0.05). Conclusion Fractional-dose 17DD-YF vaccine in ARD patients resulted in a high rate of seroconversion rate(> 80%) but lower than controls, with a longer but less intense viremia. This vaccine was immunogenic, safe and did not induce flares in ARD under low immunosuppression and may be indicated in YF outbreak situations and for patients who live or travel to endemic areas.
  • conferenceObject
    PREDICTORS OF MORTALITY IN RA PATIENTS BEFORE THE ADVENT OF BIOLOGIC THERAPY
    (2018) ROSARIO, D. C.; BULHOES, C. N.; TOLEDO, R. P.; BONGLIOLI, K.; RIBEIRO, A. C. M.; MORAES, J. C. B.; SAAD, C. G. S.; SILVA, C. A.; BONFA, E.; AIKAWA, N. E.
  • 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
    Immunogenicity and Safety of Two Doses of Influenza A H1N1/2009 Vaccine in Young Autoimmune Rheumatic Diseases Patients Under 9 Years Old
    (2012) TRUDES, Guilherme; AIKAWA, Nadia E.; CAMPOS, Lucia M.; PEREIRA, Rosa M. R.; MORAES, Julio C. B.; RIBEIRO, Ana Cristina; MIRAGLIA, Joao; TIMENETSKY, Maria do Carmo S.; BONFA, Eloisa; SILVA, Clovis Artur
    Background/Purpose: In 2010 the Advisory Committee on Immunization Practices from the CDC recommended that all children should receive the rivalent seasonal influenza vaccine containing the A/California/7/2009 (H1N1)-like virus with a specific protocol of two doses in subjects under 9 years old. There is, however, no data regarding this vaccine immunogenicity and safety in young children with autoimmune rheumatic diseases (ARD). Methods: 42 ARD patients and 12 healthy controls were initially recruited. One juvenile idiopathic arthritis patient had typical uncomplicated febrile seizure after first dose and did not receive the second dose and 3 patients and one control did not complete the study. Therefore, 38 ARD patients [25 juvenile idiopathic arthritis, 5 juvenile dermatomyositis, 3 juvenile systemic lupus erythematosus, 3 juvenile scleroderma and 2 primary vasculitis] and 11 healthy children completed the study and received two doses of a non-adjuvanted preparation of influenza A/California/7/2009 (H1N1) virus-like vaccine. They were clinically evaluated before and 21 days after the second dose of vaccination and serology for anti-H1N1 antibody was performed by hemagglutination inhibition (HI) assay. Seroprotection and seroconversion rates, geometric mean titres (GMT) and factor increase (FI) in GMT (ratio of the GMT after vaccination to the GMT before vaccination) were calculated. Adverse events were also evaluated. Results: Current age (7 vs. 7.8 years, p=0.55) and female gender (76. vs. 63.6%, p=0.45) were comparable in ARD patients and controls. Five (13.2%) patients were not receiving any drug, 18 (47.4%) patients were under non-steroidal anti-inflammatory drugs and 11 (28.9%) under prednisone, with a median current dose of 15mg (4–40). Twenty-three (60.5%) were taking methotrexate, 6 (15.8%) cyclosporine, one (2.6%) azathioprine and 7 (18.4%) anti-TNF agents. Pre-vaccination seroprotection rates (p=1.0) and GMT (p=0.63) were comparable between patients and controls. Three weeks after immunization seroprotection (81.6 vs. 81.8%; p=1.0), seroconversion rates (81.6 vs. 90.9%; p=0.66), GMT (151.5 vs. 282.1, p=0.26) and the FI in GMT (16.7 vs. 36.3; p=0.226) were similar in patients and controls, with both groups achieving adequate response according to the European Medicines Agency and Food and Drug Administration standards. The analysis of the possible factors influencing seroconversion showed no difference in demographic data, leukocytes and lymphocytes count or frequency of immunosuppressive drugs use (including prednisone, methotrexate, cyclosporine, azathioprine and anti-TNF agents) between seroconverted and non-seroconverted patients (p> 0.05). No severe adverse events were observed. Conclusion: Two doses of the non-adjuvanted influenza A H1N1/2009 vaccination induced an effective antibody response in young children with ARD independent of demographic characteristics, lymphocytes count and immunosuppressive treatment. Adverse events were rarely observed suggesting vaccine recommendation for this group of patients. (ClinicalTrials.gov,#NCT01151644)
  • article 27 Citação(ões) na Scopus
    Effective seroconversion and safety following the pandemic influenza vaccination (anti-H1N1) in patients with juvenile idiopathic arthritis
    (2013) AIKAWA, N. E.; CAMPOS, L. M. A.; GOLDENSTEIN-SCHAINBERG, C.; SAAD, C. G. S.; RIBEIRO, A. C.; BUENO, C.; PRECIOSO, A. R.; TIMENETSKY, MdoC; SILVA, C. A. A.; BONFA, E.
    Objectives: To assess the vaccine response in juvenile idiopathic arthritis (JIA) as an extension of previous observation of immunogenicity and safety of a non-adjuvanted influenza A H1N1/2009 vaccine in a large population of juvenile rheumatic diseases. Moreover, to assess the possible influence of demographic data, disease subtypes, disease activity, and treatment on immunogenicity and the potential deleterious effect of the vaccine in the disease itself, particularly in the number of arthritis and inflammatory markers. Methods: A total of 95 patients with JIA and 91 healthy controls were evaluated before and 21 days after vaccination, and serology for anti-H1N1 was performed by haemagglutination inhibition assay (HIA). Patient and physician visual analogue scales (VAS), Childhood Health Assessment Questionnaire (CHAQ), number of active joints, acute phase reactants, and treatments were evaluated before and after vaccination. Adverse events were also reported. Results: JIA patients and controls were comparable regarding mean current age (14.9 +/- 3.2 vs. 14.6 +/- 3.7 years, p = 0.182). After vaccination, the seroconversion rate was significantly lower in JIA patients compared to controls (83.2% vs. 95.6%, p = 0.008), particularly in the polyarticular subtype (80% vs. 95.6%, p = 0.0098). Of note, JIA subtypes, number of active joints, acute phase reactants, CHAQ, patient and physician VAS, and use of disease-modifying anti-rheumatic drugs (DMARDs)/immunosuppressive drugs were similar between seroconverted and non-seroconverted patients (p > 0.05). Regarding vaccine safety, no deterioration was observed in the number of active joints and acute phase reactants during the study period. Conclusion: Influenza A H1N1/2009 vaccination in JIA induces a lower but effective protective antibody response probably independent of disease parameters and treatment with an adequate disease safety profile.
  • article 10 Citação(ões) na Scopus
    Systemic and localized infection by Candida species in patients with rheumatic diseases receiving anti-TNF therapy
    (2016) AIKAWA, Nadia E.; ROSA, Daniela T. A.; NEGRO, Gilda M. B. Del; MORAES, Julio C. B.; RIBEIRO, Ana C. M.; SAAD, Carla Goncalves; SILVA, Clovis A.; BONFA, Eloisa
    Objective: To evaluate the prevalence of systemic and localized infection by Candida species and its possible association with demographic, clinical and laboratory manifestations and therapy in patients with rheumatic diseases taking TNF blockers. Methods: Consecutive patients with rheumatic diseases receiving anti-TNF agents were included. The following risk factors up to four weeks prior to the study were analyzed: use of antibiotics, immunosuppressant drugs, hospitalization and invasive procedures. All subjects were evaluated for clinical complaints; specific blood cultures were obtained for fungi and blood samples were collected for Candida spp. detection by polymerase chain reaction. Results: 194 patients [67 with rheumatoid arthritis (RA), 47 with ankylosing spondylitis (AS), 36 with juvenile idiopathic arthritis (JIA), 28 with psoriatic arthritis and 16 with other conditions] were included. The average age of patients was 42 +/- 16 years, with 68 (35%) male and mean disease duration of 15 +/- 10 years. Sixty-four (33%) patients were receiving adalimumab, 59 (30%) etanercept and 71 (36%) infliximab. Eighty-one percent of patients were concomitantly taking immunosuppressant drugs. At the time of the study, only one (0.5%) patient had localized fungal infection (vaginal candidiasis). None of the patients included had systemic candidiasis with positive blood cultures for fungi or IDCR positive for Candida spp. in peripheral blood sample. Conclusions: This was the first study to assess the prevalence of invasive and localized fungal disease by Candida in a significant number of patients with rheumatic diseases on anti-TNF therapy, and demonstrated low risk of candidiasis, despite the high prevalence of immunosuppressive drug use. (C) 2015 Elsevier Editora Ltda.
  • conferenceObject
    SARS-COV-2 VACCINE IN SPONDYLOARTHRITIS PATIENTS: OVERALL MODERATE/HIGH IMMUNOGENICITY IMPAIRED BY IMMUNOSUPPRESSANTS AND BIOLOGICAL THERAPY
    (2022) SAAD, C.; SILVA, M. Rodrigues; SAMPAIO-BARROS, P. Degrava; MORAES, J.; GOLDENSTEIN-SCHAINBERG, C.; AIKAWA, N.; NEVES, E.; PASOTO, S.; PEDROSA, T.; AOYAMA, R. Kenji; ARAUJO, C. Scognamiglio Renner; SILVA, C.; RIBEIRO, A. C. Medeiros; BONFA, E.
  • article 15 Citação(ões) na Scopus
    Pandemic unadjuvanted influenza A (H1N1) vaccine in dermatomyositis and polymyositis: Immunogenicity independent of therapy and no harmful effect in disease
    (2012) SHINJO, Samuel Katsuyuki; MORAES, Julio Cesar Bertacini de; LEVY-NETO, Mauricio; AIKAWA, Nadia Emi; RIBEIRO, Ana Cristina de Medeiros; SAAD, Carla Goncalves Schahin; PRECIOSO, Alexander; SILVA, Clovis Artur; BONFA, Eloisa
    The goal of the present study was to evaluate the influence of the influenza A H1N1/2009 vaccine on dermatomyositis/polymyositis (DM/PM) disease parameters and the potential deleterious effect of therapy on immune response. Thirty-seven DM and 21 PM patients (Bohan and Peter's criteria) were gender- and age-matched to 116 healthy controls. Seroprotection, seroconversion, the geometric mean titers (GMTs) and the factor increase (FI) in the GMTs were calculated. Disease safety was determined from a muscle enzyme analysis and the DM/PM scores [patient's visual analog scale (VAS), physician's VAS, manual muscle strength (MMT-8)] evaluated pre- and post-vaccination. The mean age (43.1 +/- 9.9 vs. 43.8 +/- 8.4 years, p = 0.607) and gender distribution (p = 1.00) were comparable between the patients and controls. After 21 days, seroconversion (p = 0.394), seroprotection (p = 0.08), GMT (p = 0.573) and the FI in the GMT (p = 0.496) were similar in both groups. The disease and muscle parameters remained stable throughout the study, including the creatine kinase (p = 0.20) and aldolase levels (p = 0.98), the physicians' VAS (p = 1.00), the patients' VAS (p = 1.00) and the MMT-8 (p = 1.00). Regarding the influence of treatment, the seroconversion rates were comparable between the controls and patients undergoing treatment with glucocorticoid (GC) (p = 0.969), GC >0.5 mg/kg/day (p = 0.395) and GC + immunosuppressors (p = 0.285). Vaccine-related adverse events were mild and similar in the DM/PM and control groups (p > 0.05). Our data support the administration of the pandemic influenza A H1N1/2009 vaccination in DM/PM, as we found no short-term harmful effects related to the disease itself and adequate immunogenicity in spite of therapy. Further studies are necessary to identify any long-term adverse effects in patients with these diseases.(c) 2012 Elsevier Ltd. All rights reserved.