ANA LUISA GARCIA CALICH
Projetos de Pesquisa
Unidades Organizacionais
FFM, 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
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Resultados de Busca
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conferenceObject EFFECT OF LONG-TERM TNF BLOCKAGE ON LIPID PROFILE IN ANKYLOSING SPONDYLITIS PATIENTS(2012) MORAES, J. C.; SOUZA, F. H. C.; RIBEIRO, A. C. D. M.; SAAD, C. G. S.; CALICH, A. L.; SILVA, C. A.; BONFA, E.- 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, EloisaBackground 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)
- Anti-ribosomal P protein: a novel antibody in autoimmune hepatitis(2013) CALICH, Ana L.; VIANA, Vilma S. T.; CANCADO, Eduardo; TUSTUMI, Francisco; TERRABUIO, Debora R. B.; LEON, Elaine P.; SILVA, Clovis A.; BORBA, Eduardo F.; BONFA, EloisaBackground Autoantibodies to ribosomal P proteins (anti-rib P) are specific serological markers for systemic lupus erythematosus (SLE) and are associated with liver involvement in this disease. The similarity in autoimmune background between autoimmune hepatitis (AIH) and SLE-associated hepatitis raises the possibility that anti-rib P antibodies might also have relevance in AIH. Aims To evaluate the frequency and clinical significance of anti-rib P antibodies in a large AIH cohort. Methods Sera obtained at diagnosis of 96 AIH patients and of 82 healthy controls were tested for IgG anti-ribosomal P protein by ELISA. All of the sera were also screened for other lupus-specific autoantibodies, three patients with the presence of anti-dsDNA (n=1) and anti-Sm (n=2) were excluded. Results Moderate to high titres (>40U) of anti-rib P antibody were found in 9.7% (9/93) of the AIH patients and none of the controls (P=0.003). At presentation, AIH patients with and without anti-rib P antibodies had similar demographic/clinical features, including the frequency of cirrhosis (44.4 vs. 28.5%, P=0.44), hepatic laboratorial findings (0.05). Importantly, at the final observation (follow-up period 10.2 +/- 4.9years), the AIH patients with anti-rib P had a significantly higher frequency of cirrhosis compared with the negative group (100 vs. 60%, P=0.04). Conclusion The novel demonstration of anti-rib P in AIH patients without clinical or laboratory evidence of SLE suggests a common underlying mechanism targeting the liver in these two diseases. In addition, this antibody appears to predict the patients with worse AIH prognoses.
- Persistent Periodontal Disease Hampers Anti-Tumor Necrosis Factor Treatment Response in Rheumatoid Arthritis(2012) SAVIOLI, Cynthia; RIBEIRO, Ana Cristina M.; FABRI, Gisele Maria Campos; CALICH, Ana Luisa; CARVALHO, Jozelio; SILVA, Clovis A.; VIANA, Vilma S. T.; BONFA, Eloisa; SIQUEIRA, Jose Tadeu T.Objective: This study aimed to evaluate prospectively the influence and the evolution of periodontal disease (PD) in rheumatoid arthritis (RA) patients submitted to anti-tumor necrosis factor (TNF) therapy. Methods: Eighteen patients with RA (according to the American College of Rheumatology criteria) were assessed for PD before (BL) and after 6 months (6M) of anti-TNF treatment: 15 infliximab, 2 adalimumab, and 1 etanercept. Periodontal assessment included plaque and gingival bleeding indices, probing pocket depth, cementoenamel junction, and clinical attachment level. Rheumatologic evaluation was performed blinded to the dentist's assessment: demographic data, clinical manifestations, and disease activity (Disease Activity Score using 28 joints [DAS28], erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]). Results: The median age and disease duration of patients with RA were 50 years (25-71 y) and 94% were female. Periodontal disease was diagnosed in 8 patients (44.4%). Comparing BL to 6M, periodontal parameters in the entire group remained stable (P > 0.05) throughout the study (plaque and gingival bleeding indices, probing pocket depth, cementoenamel junction, and clinical attachment level), whereas an improvement in most analyzed RA parameters was observed in the same period: DAS28 (5.5 vs. 3.9, P = 0.02), ESR (21 vs. 12.5 mm/first hour, P = 0.07), and CRP (7.8 vs. 2.8 mg/dL, P = 0.25). Further analysis revealed that this improvement was restricted to the group of patients without PD (DAS28 [5.5 vs. 3.6, P = 0.04], ESR [23.0 vs. 11.5 mm/first hour, P = 0.008], and CRP [7.4 vs. 2.1, P = 0.01]). In contrast, patients with PD had lack of response, with no significant differences in disease activity parameters between BL and 6M: DAS28 (5.2 vs. 4.4, P = 0.11), ESR (17.0 vs. 21.0, P = 0.56), and CRP (9.0 vs. 8.8, P = 0.55). Conclusions: This study supports the notion that PD may affect TNF blocker efficacy in patients with RA. The possibility that a sustained gingival inflammatory state may hamper treatment response in this disease has high clinical interest because this is a treatable condition.
- 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 EFFECT OF LONG-TERM TNF BLOCKAGE ON LIPID PROFILE IN ANKYLOSING SPONDYLITIS PATIENTS(2012) MORAES, J. C.; SOUZA, F. H. C.; RIBEIRO, A. C. M.; SAAD, C. G. S.; CALICH, A. L.; SCHAINBERG, C. G.; SILVA, C. A.; BONFA, E.Introduction: Ankylosing spondylitis (AS) patients have increased cardiovascular (CV) morbidity and mortality. Lipid profile plays an important role in development of CV disease and there are no data regarding prospective long-term evaluation of lipid profile in AS patients under TNF blockers. Aims: to evaluate prospectively the long-term effect of anti-TNF therapy on lipid profile in AS patients and its possible association with clinical and disease parameters. Materials and Methods: Thirty-seven consecutive AS patients, who were eligible to receive anti-TNF therapy, were prospectively enrolled. All patients were treated with TNF blockers, and they were evaluated for lipid profile, atherogenic index (AI), body mass index (BMI), waist circumference and disease parameters at baseline and at 52 and 104 weeks after treatment. Patients using statins or with LDLcholesterol >160 mg/dL were considered at risk. Results: Prospective evaluation of lipid profile revealed a significant increase in levels of LDL-cholesterol (98±27mg/dL vs. 109±30mg/dL vs 117±33mg/dL, p=0.029) and a trend for an increase in total cholesterol in the same period (168±33mg/ dL vs. 181±35mg/dL vs. 187±39mg/dL, p=0.057). No changes were found in the concentration of HDL-cholesterol (45 (37-58)mg/dL vs. 48 (42-61)mg/dL vs. 50 (43-59)mg/dL p=0.20) and triglycerides (93 (75-133)mg/dL vs. 88 (72-118)mg/dL vs. 95 (76-125)mg/dL p=0.84) or in AI (3.7±1.1 vs. 3.7±0.9 vs. 3.8±1.0 p=0.87) was observed. The proportion of patients considered at risk remained unchanged (5.5% vs. 13.5% vs. 16.2%, p=0.24). BMI (26.0±4.6kg/m2 vs. 26.4±4.6kg/m2 vs. 26.7±4.9kg/m2, p=0.78) and waist circumference (89.7±12.6cm vs. 92.1±12.2cm vs. 94.1±12.7cm, p=0.49) values remained stable throughout the study. Treatment with anti-TNF improved all disease parameters: BASDAI (p<0.001), BASFI (p<0.001), ASQoL (p=0.004), C-reactive protein (p<0.001), and erythrocyte sedimentation rate (p<0.001). Conclusions: The novel demonstration that anti-TNF therapy has a long-term deleterious effect in LDL-cholesterol levels in AS patients, reinforces the recommendation for a close monitoring and early intervention in this modifiable cardiovascular risk factor.