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Nieto R, Quintana R, Zavala-Flores E, Serrano R, Roberts K, Catoggio LJ, García MA, Berbotto GA, Saurit V, Bonfa E, Borba EF, Lavras Costallat LT, Da Silva NA, Sato EI, Tavares Brenol JC, Massardo L, Neira OJ, Vázquez G, Guibert Toledano M, Pascual-Ramos V, Sauza Del Pozo MJ, Barile-Fabris LA, Amigo MC, García De La Torre I, Acevedo-Vásquez EM, Segami MI, Chacón-Díaz R, Esteva-Spinetti MH, Alarcón GS, Pons-Estel BA, Pons-Estel GJ. Time to diagnosis in systemic lupus erythematosus: Associated factors and its impact on damage accrual and mortality. Data from a multi-ethnic, multinational Latin American lupus cohort. Lupus 2024; 33:340-346. [PMID: 38334100 DOI: 10.1177/09612033241232821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) often mimics symptoms of other diseases, and the interval between symptom onset and diagnosis may be long in some of these patients. Aims: To describe the characteristics associated with the time to SLE diagnosis and its impact on damage accrual and mortality in patients with SLE from a Latin American inception cohort. METHODS Patients were from a multi-ethnic, multi-national Latin-American SLE inception cohort. All participating centers had specialized lupus clinics. Socio-demographic, clinical/laboratory, disease activity, damage, and mortality between those with a longer and a shorter time to diagnosis were compared using descriptive statistical tests. Multivariable Cox regression models with damage accrual and mortality as the end points were performed, adjusting for age at SLE diagnosis, gender, ethnicity, level of education, and highest dose of prednisone for damage accrual, plus highest dose of prednisone, baseline SLEDAI, and baseline SDI for mortality. RESULTS Of the 1437 included in these analyses, the median time to diagnosis was 6.0 months (Q1-Q3 2.4-16.2); in 721 (50.2%) the time to diagnosis was longer than 6 months. Patients whose diagnosis took longer than 6 months were more frequently female, older at diagnosis, of Mestizo ethnicity, not having medical insurance, and having "non-classic" SLE symptoms. Longer time to diagnosis had no impact on either damage accrual (HR 1.09, 95% CI 0.93-1.28, p = 0.300) or mortality (HR 1.37, 95% CI 0.88-2.12, p = 0.200). CONCLUSIONS In this inception cohort, a maximum time of 24 months with a median of 6 months to SLE diagnosis had no apparent negative impact on disease outcomes (damage accrual and mortality).
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Affiliation(s)
- Romina Nieto
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | - Rosa Serrano
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Karen Roberts
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Luis J Catoggio
- Rheumatology Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mercedes A García
- Servicio de Reumatología, HIGA San Martin de La Plata, Buenos Aires, Argentina
| | - Guillermo A Berbotto
- Servicio de Reumatología, Hospital Escuela "Eva Perón", Granadero Baigorria, Argentina
| | - Verónica Saurit
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eduardo F Borba
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Nilzio A Da Silva
- Servico de Reumatologia, Departamento de Clinica Medica, Faculdade de Medicina, Hospital das Clínicas,Universidade Federal de Goiás, Goiania, Brazil
| | - Emilia I Sato
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Joao C Tavares Brenol
- Rheumatology Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Loreto Massardo
- Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago de Chile, Chile
| | - Oscar J Neira
- Sección de Reumatología, Hospital del Salvador, Universidad de Chile, Unidad de Reumatología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Gloria Vázquez
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Hospital Universitario, Fundación San Vicente, Medellín, Colombia
| | - Marlene Guibert Toledano
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba
| | - Virginia Pascual-Ramos
- Virginia Pascual-Ramos, Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, México
| | - María J Sauza Del Pozo
- Maria Josefina Sauza del Pozo, Laura E. Aranda Baca, and Adelfia Urenda Quezada, Servicio de Reumatología, Insti- tuto Mexicano de Seguro Social, Hospital de Especialidades No 25, Monterrey, México
| | | | | | - Ignacio García De La Torre
- Departamento de Inmunología y Reumatología, Hospital General de Occidente de la S.S. y Universidad de Guadalajara, Zapopan, Jalisco, México
| | | | - María I Segami
- Servicio de Reumatología, Hospital General Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Rosa Chacón-Díaz
- Servicio de Reumatología, Policlínica Méndez Gimón, Caracas, Venezuela
| | - María H Esteva-Spinetti
- Servicio de Reumatología, Departamento de Medicina, Hospital Central de San Cristóbal, San Cristóbal, Venezuela
| | - Graciela S Alarcón
- Universidad Peruana Cayetano Heredia, Lima, Perú
- The University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
| | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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Pasoto SG, Villamarín LEB, de Vinci Kanda Kupa L, Deveza GBH, Ribeiro CT, Emi Aikawa N, Leon EP, de Oliveira Martins VA, Silva CA, Bonfa E. Assessment of hydroxychloroquine blood levels in Sjögren's disease patients: drug adherence and clinical associations. Rheumatol Int 2024:10.1007/s00296-024-05545-0. [PMID: 38294544 DOI: 10.1007/s00296-024-05545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
Hydroxychloroquine (HCQ) has been used to treat Sjögren's disease (SjD) patients. However, there are no studies evaluating drug adherence through HCQ blood levels, pharmacy refill (PR) and medication adherence questionnaires. The relationship of HCQ blood levels with glandular/extraglandular disease parameters was also poorly assessed. This cross-sectional observational study included 74 adult SjD patients, who were receiving a stable HCQ dose (4-5.5 mg/kg/day, actual weight) for at least 3 months before study inclusion. HCQ blood levels were quantified by high-performance liquid chromatography coupled to mass spectrometry. Adherence was assessed by PR and Medida de Adesão aos Tratamentos (MAT) questionnaire. The following parameters were evaluated: Xerostomia Inventory, Ocular Surface Disease Index, EULAR (European League Against Rheumatism) Sjögren's Syndrome Disease Activity Index, EULAR Sjögren's Syndrome Patient Reported Index, Schirmer's I test and non-stimulated/stimulated salivary flow rates. HCQ blood levels were 775.3(25.0-2,568.6)ng/mL. Eleven patients (14.9%) had HCQ blood levels < 200ng/mL (non-adherent group); 11(14.9%), 200-499ng/mL (sub-therapeutic levels group); and 52(70.2%), ≥ 500ng/mL (adherent group). PR classified incorrectly all non-adherent/sub-therapeutic patients and 2/52(3.9%) adherent patients. Using MAT, the overall misclassification was 24/52(46.2%) in the adherent group, and were correctly identified 9/11(81.8%) patients in non-adherent and 7/11(63.6%) in sub-therapeutic groups. MAT sensitivity and specificity to identify non-adherent/sub-therapeutic patients were 72.7% and 53.9%, respectively. The three groups were comparable regarding glandular/extraglandular disease parameters (p > 0.05). The assessment of HCQ blood levels is a promising tool for evaluating drug adherence in SjD. This is particularly crucial as one-third of patients exhibited non-adherence/sub-therapeutic levels, and neither PR nor MAT reliably identified these patients.
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Affiliation(s)
- Sandra Gofinet Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
- Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3o andar (Disciplina de Reumatologia), sala 3192, São Paulo, 01246-903, SP, Brazil.
| | | | - Léonard de Vinci Kanda Kupa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Giordano Bruno Henriques Deveza
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carolina Torres Ribeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Nádia Emi Aikawa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Elaine Pires Leon
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Clovis Artur Silva
- Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Smaira FI, Mazzolani BC, Lemes ÍR, da Silva RP, Pinto AJ, Sieczkowska SM, Aikawa NE, Pasoto SG, Medeiros-Ribeiro AC, Saad CGS, Yuk EFN, Silva CA, Swinton P, Kupa LDVK, Hallal PC, Roschel H, Gualano B, Bonfa E. No Associations Between Physical Activity and Immunogenicity in SARS-CoV-2 Seropositive Patients With Autoimmune Rheumatic Diseases Prior to and After Vaccination. J Phys Act Health 2023; 20:980-983. [PMID: 37290768 DOI: 10.1123/jpah.2022-0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 06/10/2023]
Abstract
AIM To investigate the association between physical activity and immunogenicity among SARS-CoV-2 seropositive patients with autoimmune rheumatic diseases prior to and following a 2-dose schedule of CoronaVac (Sinovac inactivated vaccine). METHODS This was a prospective cohort study within an open-label, single-arm, phase 4 vaccination trial conducted in Sao Paulo, Brazil. In this substudy, only SARS-CoV-2 seropositive patients were included. Immunogenicity was assessed by seroconversion rates of total anti-SARS-CoV-2 S1/S2 immunoglobulin G (IgG), geometric mean titers of anti-S1/S2 IgG, frequency of positive neutralizing antibodies, and neutralizing activity before and after vaccination. Physical activity was assessed through a questionnaire. Model-based analyses were performed controlling for age (<60 or ≥60 y), sex, body mass index (<25, 25-30, and >30 kg/m2), and use of prednisone, immunosuppressants, and biologics. RESULTS A total of 180 seropositive autoimmune rheumatic disease patients were included. There was no association between physical activity and immunogenicity before and after vaccination. CONCLUSIONS This study suggests that the positive association between physical activity and greater antibody responses seen in immunocompromised individuals following vaccination is overridden by previous SARS-CoV-2 infection, and does not extend to natural immunity.
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Affiliation(s)
- Fabiana Infante Smaira
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, SP,Brazil
| | - Bruna Caruso Mazzolani
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, SP,Brazil
| | - Ítalo Ribeiro Lemes
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, SP,Brazil
| | - Rafael Pires da Silva
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, SP,Brazil
| | - Ana J Pinto
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, SP,Brazil
- Division of Endocrinology, Metabolism, and Diabetes and Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO,USA
| | - Sofia M Sieczkowska
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, SP,Brazil
| | - Nadia E Aikawa
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,Brazil
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,Brazil
| | - Ana C Medeiros-Ribeiro
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,Brazil
| | - Carla G S Saad
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,Brazil
| | - Emily F N Yuk
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,Brazil
| | - Paul Swinton
- Robert Gordon University, Aberdeen,United Kingdom
| | - Leonard de Vinci Kanda Kupa
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,Brazil
| | - Pedro C Hallal
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS,Brazil
| | - Hamilton Roschel
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, SP,Brazil
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, SP,Brazil
- Food Research Center, University of São Paulo, Sao Paulo, SP,Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,Brazil
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Pasoto SG, Borba EF, Formiga FFC, do Nascimento Pedrosa T, Aikawa NE, de Siqueira MAMT, Capão ASV, de Proença ACT, Fuller R, Yuki EFN, Leon EP, de Oliveira Martins VA, Lopes MH, da Silva Duarte AJ, da Silva CAA, Bonfa E. Robust immunogenicity to the H3N2 component of influenza A vaccine in primary Sjögren syndrome. Clin Rheumatol 2023; 42:2419-2425. [PMID: 37306813 DOI: 10.1007/s10067-023-06666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Influenza A (H3N2) virus is the major cause of morbidity/mortality due to seasonal influenza over 50 years. Data about the safety/immunogenicity of influenza A/Singapore (H3N2) vaccine are scarce in primary Sjögren syndrome (pSS). METHODS Twenty-one consecutive pSS patients and 42 HC (healthy control individuals) were immunized with influenza A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus. Rates of SP (seroprotection) and SC (seroconversion), GMT (geometric mean titers), FI-GMT (factor increase in GMT), ESSDAI (EULAR Sjögren's Syndrome Disease Activity Index), and adverse events were appraised before and 4 weeks post-vaccination. RESULTS pSS and HC had similar mean age (51.2 ± 14.2 vs. 50.6 ± 12.1 years, p = 0.886). Pre-vaccination SP rates were high in pSS and HC (90.5% vs. 71.4%, p = 0.114), and GMT were higher in pSS [80.0 (52.4-160.0) vs. 40.0 (20.0-80.0), p = 0.001]. The percentage of influenza vaccination in the preceding two years was elevated and similar in pSS and HC (94.1% vs. 94.6%, p = 1.000). GMT values augmented in both groups four weeks after vaccination and persisted higher in the first group [160.0 (80.0-320.0) vs. 80.0 (40.0-80.0), p < 0.001] with equivalent FI-GMT [1.4 (1.0-2.8) vs. 1.4 (1.0-2.0), p = 0.410]. Both groups had low and similar SC rates (19.0% vs. 9.5%, p = 0.423). ESSDAI values persisted steadily during the study (p = 0.313). No serious adverse events have occurred. CONCLUSION The novel demonstration that the influenza A/Singapore (H3N2) vaccine induces a different pattern of immunogenicity from other influenza A constituents in pSS, featured by a desirable high pre- and post-vaccination immunogenicity, is in line with reported differences in immune responses between strains in trivalent vaccines and may be related to pre-existing immunity. CLINICALTRIALS gov: #NCT03540823. Key Points • This prospective study demonstrated a robust pre- and post-vaccination immunogenicity to influenza A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus in primary Sjögren's syndrome (pSS). • This high immunogenicity pattern may be related to pre-existing immunization, or else it is related to immunogenicity differences of each strain. • This vaccine had an adequate safety profile in pSS, with no impact on disease activity.
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Affiliation(s)
- Sandra Gofinet Pasoto
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil.
| | - Eduardo Ferreira Borba
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
| | - Francisco Fellipe Claudino Formiga
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
| | - Tatiana do Nascimento Pedrosa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
| | - Nadia Emi Aikawa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
- Pediatric Rheumatology Unit, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
| | | | - Artur Silva Vidal Capão
- Laboratory of Respiratory Virus and Measles, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Adriana Coracini Tonacio de Proença
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
| | - Ricardo Fuller
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
| | - Emily Figueiredo Neves Yuki
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
| | - Elaine Pires Leon
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
| | - Victor Adriano de Oliveira Martins
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
| | - Marta Heloisa Lopes
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
| | - Alberto José da Silva Duarte
- Clinical Laboratory Division, Department of Pathology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
| | - Clovis Artur Almeida da Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, 01246-903, Brazil
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5
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Silva CA, de Vinci Kanda Kupa L, Medeiros-Ribeiro AC, Pasoto SG, Saad CGS, Yuki EFN, Landim JIVD, Léda VHFE, de Camargo Correia LS, Sartori AF, Martins CCMF, Ribeiro CT, Waridel F, de Oliveira Martins VA, Shinjo SK, Andrade DCO, Sampaio-Barros PD, Neto EFB, Aikawa NE, Bonfa E. Post-acute COVID-19 in three doses vaccinated autoimmune rheumatic diseases patients: frequency and pattern of this condition. Adv Rheumatol 2023; 63:26. [PMID: 37291679 PMCID: PMC10248954 DOI: 10.1186/s42358-023-00309-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Data on post-acute COVID-19 in autoimmune rheumatic diseases (ARD) are scarce, focusing on a single disease, with variable definitions of this condition and time of vaccination. The aim of this study was to evaluate the frequency and pattern of post-acute COVID-19 in vaccinated patients with ARD using established diagnosis criteria. METHODS Retrospective evaluation of a prospective cohort of 108 ARD patients and 32 non-ARD controls, diagnosed with SARS-CoV-2 infection (RT-PCR/antigen test) after the third dose of the CoronaVac vaccine. Post-acute COVID-19 (≥ 4 weeks and > 12 weeks of SARS-CoV-2 symptoms) were registered according to the established international criteria. RESULTS ARD patients and non-ARD controls, balanced for age and sex, had high and comparable frequencies of ≥ 4 weeks post-acute COVID-19 (58.3% vs. 53.1%, p = 0.6854) and > 12 weeks post-acute COVID-19 (39.8% vs. 46.9%, p = 0.5419). Regarding ≥ 4 weeks post-acute COVID-19, frequencies of ≥ 3 symptoms were similar in ARD and non-ARD controls (54% vs. 41.2%, p = 0.7886), and this was also similar in > 12 weeks post-acute COVID-19 (68.3% vs. 88.2%, p = 0.1322). Further analysis of the risk factors for ≥ 4 weeks post-acute COVID-19 in ARD patients revealed that age, sex, clinical severity of COVID-19, reinfection, and autoimmune diseases were not associated with this condition (p > 0.05). The clinical manifestations of post-acute COVID-19 were similar in both groups (p > 0.05), with fatigue and memory loss being the most frequent manifestations. CONCLUSION We provide novel data demonstrating that immune/inflammatory ARD disturbances after third dose vaccination do not seem to be a major determinant of post-acute COVID-19 since its pattern is very similar to that of the general population. Clinical Trials platform (NCT04754698).
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Affiliation(s)
- Clovis Artur Silva
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Leonard de Vinci Kanda Kupa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Ana Cristina Medeiros-Ribeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Sandra Gofinet Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Carla Gonçalves Schahin Saad
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Emily Figueiredo Neves Yuki
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Joaquim Ivo Vasques Dantas Landim
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Victor Hugo Ferreira E Léda
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Luisa Sacchi de Camargo Correia
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Artur Fonseca Sartori
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Carolina Campagnoli Machado Freire Martins
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Carolina Torres Ribeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Filipe Waridel
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Victor Adriano de Oliveira Martins
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Samuel Katsuyuki Shinjo
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Danieli Castro Oliveira Andrade
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Percival Degrava Sampaio-Barros
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Eduardo Ferreira Borba Neto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Nadia Emi Aikawa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP, 01246-903, Brazil.
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Munhoz GA, Aikawa NE, Silva CA, Pasoto SG, Pedrosa TN, Seguro LPC, Bonfa E, Borba EF. Short-term Accrual 2019 European League Against Rheumatism/American College of Rheumatology Domains and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage in Lupus Patients With and Without Nephritis at Disease Onset. J Clin Rheumatol 2023; 29:190-195. [PMID: 36683233 DOI: 10.1097/rhu.0000000000001939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To determine in a historical inception cohort the impact of lupus nephritis at disease onset in short-term accrual 2019 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) domains. The possible association with treatment and damage was also investigated. METHODS One hundred thirty-three consecutive adult systemic lupus erythematosus patients according to the 2019 EULAR/ACR criteria were divided according to the presence (RENAL-lupus) or absence of renal involvement (NONRENAL-lupus) at disease onset. The 2019 EULAR/ACR score and Systemic Lupus International Collaborating Clinics/ACR (SDI) were longitudinally evaluated over 3 years. RESULTS RENAL-lupus (n = 49 [36.8%]) and NONRENAL-lupus (n = 84 [63.2%]) were similar regarding age ( p = 0.704), female sex ( p = 0.313), and black race ( p = 0.506). At study entry, RENAL-lupus had higher 2019 EULAR/ACR total domains (30 [12-42] vs. 22 [10-36], p < 0.001) and used more often glucocorticoid ( p < 0.001), mycophenolate mofetil ( p = 0.007), and cyclophosphamide ( p = 0.001). After 3 years, a stable number of domain scores was observed for the RENAL-lupus (30 [12-42] vs. 30 [12-42], p = 0.125), whereas an increase was observed for the NONRENAL-lupus (22 [10-36] vs. 23 [10-40], p < 0.001) compared with baseline. Accordingly, RENAL-lupus patients had a lower frequency of additional domains (3/49 [6.1%] vs. 37/84 [44.0%], p < 0.0001). New kidney involvement occurred in 15 (44.1%) of 34 patients of the NONRENAL-lupus. Both groups evolved with a comparable increase in frequency of patients with damage (SDI ≥1) at the end of the study (23/49 [46.9%] vs. 34/89 [40.54%], p = 0.585) with a similar median of SDI (1 [0-4] vs. 0 [0-2], p = 0.132). CONCLUSIONS The distinct pattern of accrual 2019 EULAR/ACR domains in patients with and without nephritis at disease onset suggests that close surveillance for additional organ involvement, including kidney, is mandatory in NONRENAL lupus in the first 3 years of disease. The unexpected comparable early damage in both groups despite milder disease and less intense immunosuppression in NONRENAL lupus reinforces the need for new and tailored therapies for these patients.
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Affiliation(s)
| | - Nadia E Aikawa
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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7
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Sakamoto AP, Silva CA, Pita AC, Trindade VC, Islabao AG, Fiorot FJ, Lopes SR, Pereira RM, Saad-Magalhaes C, Russo GC, Len CA, Prado RD, Campos LM, Aikawa NE, Appenzeller S, Ferriani VP, Silva MF, Felix M, Fonseca AR, Assad AP, Sztajnbok FR, Santos MC, Bica BE, Sena EG, Moraes AJ, Fraga MM, Robazzi TC, Spelling PF, Scheibel IM, Cavalcanti AS, Matos EN, Guimaraes LJ, Santos FP, Mota LM, Bonfa E, Terreri MT. Risk factors for mortality in 1528 Brazilian childhood-onset systemic lupus erythematosus patients. Lupus 2023; 32:781-790. [PMID: 37070932 DOI: 10.1177/09612033231170515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVES To identify associations between mortality in cSLE patients and their characteristics: clinical and laboratory features, disease activity and damage scores, and treatment; to evaluate risk factors associated with mortality in cSLE; and to determine the most frequent causes of death in this group of patients. METHODS We performed a multicenter retrospective cohort using data from 1,528 cSLE patients followed in 27 pediatric rheumatology tertiary centers in Brazil. Patients' medical records were reviewed according to a standardized protocol, in which information regarding demographic and clinical features, disease activity and damage scores, and treatment were collected and compared between deceased cSLE patients and survivors. Univariate and multivariate analyses by Cox regression model were used to calculate risk factors for mortality, whereas survival rates were analyzed by Kaplan-Meier plots. RESULTS A total of 63/1,528 (4.1%) patients deceased, 53/63 were female (84.1%), median age at death was 11.9 (9.4-13.1) years and median time interval between cSLE diagnosis and death was 3.2 (0.5-5.3) years. Sepsis was the main cause of death in 27/63 (42.8%) patients, followed by opportunistic infections in 7/63 (11.1%), and alveolar hemorrhage in 6/63 (9.5%) patients. The regression models resulted in neuropsychiatric lupus (NP-SLE) (HR = 2.56, 95% CI = 1.48-4.42) and chronic kidney disease (CKD) (HR = 4.33, 95% CI = 2.33-4.72), as risk factors significantly associated with mortality. Overall patient survival after cSLE diagnosis at 5, 10, and 15 years were 97%, 95.4%, and 93.8%, respectively. CONCLUSIONS This study confirmed that the recent mortality rate in cSLE in Brazil is low, but still of concern. NP-SLE and CKD were the main risk factors for mortality, indicating that the magnitude of these manifestations was significantly high.
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Affiliation(s)
- Ana P Sakamoto
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana C Pita
- Pediatric Rheumatology Unit, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Vitor C Trindade
- Pediatric Rheumatology Unit, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Aline G Islabao
- Pediatric Rheumatology Unit, Hospital da Crianca de Brasilia Jose Alencar, Brasilia, DF, Brazil
| | - Fernanda J Fiorot
- Pediatric Rheumatology Unit, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra Rm Lopes
- Pediatric Rheumatology Unit, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosa Mr Pereira
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Claudia Saad-Magalhaes
- Pediatric Rheumatology Division, Sao Paulo State University (UNESP) - Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
| | - Gleice Cs Russo
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Claudio A Len
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rogerio do Prado
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Lucia Ma Campos
- Pediatric Rheumatology Unit, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nadia E Aikawa
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology - School of Medical Science - University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Virginia Pl Ferriani
- Pediatric Rheumatology Unit, Ribeirao Preto Medical School - University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Marco F Silva
- Pediatric Rheumatology Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Marta Felix
- Pediatric Rheumatology Unit, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Adriana R Fonseca
- Pediatric Rheumatology Unit, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Ana Pl Assad
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Flavio R Sztajnbok
- Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, RJ, Brazil
| | - Maria C Santos
- Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, SP, Brazil
| | - Blanca E Bica
- Rheumatology Division - Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Evaldo G Sena
- Pediatric Rheumatology Unit, Lauro Vanderley University Hospital, Joao Pessoa, PB, Brazil
| | - Ana J Moraes
- Pediatric Rheumatology Unit, Federal University of Para, Belem, PA, Brazil
| | - Melissa M Fraga
- Pediatric Rheumatology Unit, Hospital Darcy Vargas, Sao Paulo, SP, Brazil
| | - Teresa C Robazzi
- Pediatric Rheumatology Unit, Federal University of Bahia, Salvador, BA, Brazil
| | - Paulo F Spelling
- Pediatric Rheumatology Unit, Hospital Evangelico de Curitiba, Curitiba, PR, Brazil
| | - Iloite M Scheibel
- Pediatric Rheumatology Unit, Hospital Criança Conceicao, Porto Alegre, RS, Brazil
| | - Andre S Cavalcanti
- Pediatric Rheumatology Unit, Federal University of Pernambuco, Recife, PE, Brazil
| | - Erica N Matos
- Pediatric Rheumatology Unit, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | - Flavia P Santos
- Pediatric Rheumatology Unit, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Licia Mh Mota
- Rheumatology Unit, University of Brasilia, Brasilia, DF, Brazil
| | - Eloisa Bonfa
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria T Terreri
- Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
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Gualano B, Sieczkowska SM, Lemes ÍR, da Silva RP, Pinto AJ, Mazzolani BC, Smaira FI, Aikawa NE, Kupa LVK, Pasoto SG, Medeiros-Ribeiro AC, Saad CGS, Yuk EFN, Silva CA, Swinton P, Hallal PC, Roschel H, Bonfa E. Physical Activity: A Strategy to Improve Antibody Response to a SARS-CoV-2 Vaccine Booster Dose in Patients With Autoimmune Rheumatic Diseases. J Phys Act Health 2023; 20:311-316. [PMID: 36870351 DOI: 10.1123/jpah.2022-0332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/08/2022] [Accepted: 01/09/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Physical activity associates with improved immunogenicity following a 2-dose schedule of CoronaVac (Sinovac's inactivated SARS-CoV-2 vaccine) in patients with autoimmune rheumatic diseases (ARD). This study evaluates whether physical activity impacts vaccine-induced antibody responses to a booster dose in this population. METHODS This was a phase-4 trial conducted in São Paulo, Brazil. Patients with ARD underwent a 3-dose schedule of CoronaVac. One month after the booster, we assessed seroconversion rates of anti-SARS-CoV-2 S1/S2 IgG, geometric mean titers of anti-S1/S2 IgG, frequency of positive neutralizing antibodies, and neutralizing activity. Physical activity was assessed through questionnaire. RESULTS Physically active (n = 362) and inactive (n = 278) patients were comparable for most characteristics; however, physically active patients were younger (P < .01) and had a lower frequency of chronic inflammatory arthritis (P < .01). Adjusted models showed that physically active patients had ∼2 times odds of seroconversion rates (OR: 2.09; 95% confidence interval, 1.22 to 3.61), ∼22% greater geometric mean titers of anti-S1/S2 IgG (22.09%; 95% confidence interval, 3.91 to 65.60), and ∼7% greater neutralizing activity (6.76%; 95% confidence interval, 2.80 to 10.72) than inactive patients. CONCLUSIONS Patients with ARD who are physically active have greater odds of experiencing better immunogenicity to a booster dose of CoronaVac. These results support the recommendation of physical activity to improve vaccination responses, particularly for immunocompromised individuals.
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Affiliation(s)
- Bruno Gualano
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, SP,Brazil
- Food Research Center, University of São Paulo, São Paulo, SP,Brazil
| | - Sofia M Sieczkowska
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, SP,Brazil
| | - Ítalo Ribeiro Lemes
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, SP,Brazil
| | - Rafael Pires da Silva
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, SP,Brazil
| | - Ana J Pinto
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, SP,Brazil
- Division of Endocrinology, Metabolism, and Diabetes and Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO,USA
| | - Bruna C Mazzolani
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, SP,Brazil
| | - Fabiana I Smaira
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, SP,Brazil
| | - Nadia E Aikawa
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP,Brazil
| | - Leonard V K Kupa
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP,Brazil
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP,Brazil
| | - Ana C Medeiros-Ribeiro
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP,Brazil
| | - Carla G S Saad
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP,Brazil
| | - Emily F N Yuk
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP,Brazil
| | - Clovis A Silva
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP,Brazil
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP,Brazil
| | - Paul Swinton
- Robert Gordon University, Aberdeen,United Kingdom
| | - Pedro C Hallal
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS,Brazil
| | - Hamilton Roschel
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, SP,Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP,Brazil
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Jorgetti V, Pd SB, Sk S, Bonfa E. Rosa Maria Rodrigues Pereira (1958-2022). J Bone Miner Res 2023; 38:357-358. [PMID: 36653935 DOI: 10.1002/jbmr.4767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Vanda Jorgetti
- Nephrology and Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sampaio-Barros Pd
- Nephrology and Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Shinjo Sk
- Nephrology and Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfa
- Nephrology and Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Pereira RMR, Dagostin MA, Caparbo VF, Sales LP, Pasoto SG, Silva CA, Yuki EFN, Saad CGS, Medeiros-Ribeiro AC, Kupa LVK, Fusco SRG, Martins VAO, Martins CCMF, Barbas CV, Shinjo SK, Aikawa NE, Bonfa E. Anti-SARS-CoV-2 inactivated vaccine in patients with ANCA-associated vasculitis: Immunogenicity, safety, antibody decay and the booster dose. Clinics (Sao Paulo) 2023; 78:100150. [PMID: 36529052 PMCID: PMC9705212 DOI: 10.1016/j.clinsp.2022.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/10/2022] [Accepted: 11/17/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate inactivated CoronaVac prime vaccination, antibody decay, booster dose, and safety in ANCA-Associated Vasculitis (AAV) patients. METHODS Fifty-three AAV patients and 106 Controls (CG) received CoronaVac on days: D0 (first dose), D28(second dose), and D210 (booster dose, 32 AAV: 32 CG). The primary outcome was immunogenicity after the second vaccine dose (day 69) assessed by Seroconversion Rates (SC) of anti-SARS-CoV-2 S1/S2 IgG and Neutralizing Antibodies (NAb). Secondary outcomes were safety, immunogenicity (D28/D240), 6-months antibody decay (D210) and the booster dose response (D240). RESULTS At D69 SC (65.1% vs. 96.8%, p = 0.0001), GMT (21.3 UA/mL vs. 67.7 UA/mL, p < 0.001) and NAb- positivity (53.7% vs. 80.6%, p = 0.001) were moderate but lower in naïve-AAV patients than CG. Patients without SC used more often IS (93.3% vs. 53.3%, p = 0.015), mycophenolate mofetil (20% vs. 0%, p = 0.037) and prednisone (60.0% vs. 28.6%, p = 0.057) than seroconverted. NAb negativity in AAV patients was associated with prednisone treatment (57.9% vs. 18.2%, p = 0.015) and IS (84.2% vs. 55.0%, p = 0.046). Logistic regression analysis models showed that only prednisone was associated with lower seroconversion (OR = 0.2, 0,95% CI 0.05‒0.86, p = 0.030) and with lower NAb positivity (OR = 0.2, 0,95% CI 0.05‒0.88, p = 0.034). After six months (D69‒D210) a decrease in IgG positivity occurred in 32 AAV patients (15.7%, p = 0.074) and 32 CG (18.7%, p = 0.041). For the NAb positivity, the 6-month decrease was not significant (p = 0.114) whereas a major reduction occurred for CG (p < 0.001). A booster dose (D240) resulted in an increment in IgG-positivity (21.9%, p = 0.023) and NAb-positivity (34.4%, p = 0.006) in AAV patients. No moderate/severe adverse events attributable to the vaccine were observed. CONCLUSION This study provides novel data on the excellent safety and moderate immunogenicity of CoronaVac in AAV patients. A six-month mild antibody waning was observed with a good response to the booster dose, although levels remained lower than CG (CoronavRheum-NCT04754698).
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Affiliation(s)
- Rosa M R Pereira
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Marilia A Dagostin
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Valeria F Caparbo
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Lucas P Sales
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Emily F N Yuki
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Carla G S Saad
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Ana C Medeiros-Ribeiro
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Leonard V K Kupa
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Solange R G Fusco
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Victor A O Martins
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Carolina C M F Martins
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Carmen Valente Barbas
- Pulmonary Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Samuel K Shinjo
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Nadia E Aikawa
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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11
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Jorgetti V, Sampaio-Barros PD, Shinjo SK, Bonfa E. Rosa Maria Rodrigues Pereira. The Lancet Rheumatology 2022; 4:e821. [PMID: 38261389 DOI: 10.1016/s2665-9913(22)00339-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Vanda Jorgetti
- Nephrology Division, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Percival Degrava Sampaio-Barros
- Nephrology Division, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Samuel Katsuyuki Shinjo
- Nephrology Division, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Eloisa Bonfa
- Nephrology Division, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Abdo RCT, Gobbi RG, Leite CBG, Pasoto SG, Leon EP, Lima ALLM, Bonfa E, Pécora JR, Demange MK. Quantitative alpha-defensin testing: Is synovial fluid dilution important? World J Orthop 2022; 13:760-767. [PMID: 36159623 PMCID: PMC9453281 DOI: 10.5312/wjo.v13.i8.760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/04/2022] [Accepted: 08/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Alpha-defensin has been widely studied for the diagnosis of periprosthetic joint infection (PJI). However, there is a lack of detailed information regarding the proper laboratory technique of the enzyme-linked immunosorbent assay (ELISA) method, such as sample dilution.
AIM To assess the influence of dilution in the synovial fluid during ELISA for the diagnosis of knee PJI; and determine which dilution presents a better performance.
METHODS Forty samples of synovial fluid from arthroplasty knees were included, 17 in the infected group and 23 in the aseptic group, according to Musculoskeletal Infection Society criteria. Initially, five synovial fluid samples from each group were assessed for quantitative analysis of alpha-defensin using ELISA. Different dilution ratios (1:10, 1:100, 1:500, 1:1000 and 1:5000) were tested based on the predetermined cutoff value of 5.2 mg/L. The dilutions that performed better were used to compare the results of all samples.
RESULTS For infected cases, a gradual increase in the dilution of synovial fluid samples led to an equivalent increase in alpha-defensin level. The same was not observed in the aseptic cases. Both 1:1000 and 1:5000 dilutions presented satisfactory results to differentiate infected and aseptic cases. Further analyses were performed using 1:1000 and 1:5000 for all 40 samples. The 1:1000 dilution resulted in a sensitivity of 88.2% (95%CI, 66%-98%) and specificity of 95.7% (95%CI, 79%-99%), whereas the 1:5000 dilution presented a sensitivity of 94.1% (95%CI, 73%-99%) and a specificity of 100% (95%CI, 86%-100%).
CONCLUSION The synovial fluid dilution had an important influence on the alpha-defensin ELISA results. Dilutions of 1:5000 showed the best performance for the diagnosis of knee PJI. The results of this study set the basis for a more reliable and reproducible alpha-defensin ELISA during the investigation of PJI, contributing to the expansion of this technique in different treatment centers worldwide.
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Affiliation(s)
- Rodrigo Calil Teles Abdo
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
- Orthopaedic Department, HCor - Hospital do Coração, Sao Paulo 04004-030, Brazil
| | - Riccardo Gomes Gobbi
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
- Orthopaedic Department, HCor - Hospital do Coração, Sao Paulo 04004-030, Brazil
| | - Chilan Bou Ghosson Leite
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
| | - Sandra Gofinet Pasoto
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
| | - Elaine Pires Leon
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
| | - Ana Lucia Lei Munhoz Lima
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
| | - Eloisa Bonfa
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
| | - José Ricardo Pécora
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
| | - Marco Kawamura Demange
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
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Gualano B, Lemes ÍR, da Silva RP, Pinto AJ, Mazzolani BC, Smaira FI, Sieczkowska SM, Aikawa NE, Pasoto S, Medeiros-Ribeiro AC, Saad C, Yuk E, Silva C, Swinton P, Hallal PC, Roschel H, Bonfa E. Physical activity and antibody persistence 6 months after the second dose of CoronaVac in immunocompromised patients. Scand J Med Sci Sports 2022; 32:1510-1515. [PMID: 35844042 DOI: 10.1111/sms.14213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 12/17/2022]
Abstract
This prospective cohort study within an open-label, single-arm, phase 4 vaccination trial (clinicaltrials.gov #NCT04754698) aimed to investigate the association between physical activity and persistent anti-SARS-CoV-2 antibodies 6 months after two-dose schedule of CoronaVac in autoimmune rheumatic diseases (ARD) patients (n = 748). Persistent immunogenicity 6 months after the full-course vaccination was assessed using seroconversion rates of total anti-SARS-CoV-2 S1/S2 IgG, geometric mean titers of anti-S1/S2 IgG (GMT), and frequency of positive neutralizing antibodies (NAb). Physical activity was assessed trough questionnaire. Adjusted point estimates from logistic regression models indicated that physically active patients had greater odds of seroconversion rates (OR: 1.5 [95%CI: 1.1 to 2.1]) and NAb positivity (OR: 1.5 [95%CI: 1.0 to 2.1]), and approximately 43% greater GMT (42.8% [95%CI: 11.9 to 82.2]) than inactive ones. In conclusion, among immunocompromised patients, being physically active was associated with an increment in antibody persistence through 6 months after a full-course of an inactivated SARS-CoV-2 vaccine.
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Affiliation(s)
- Bruno Gualano
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, Brazil.,Food Research Center, University of São Paulo, São Paulo, Brazil
| | - Ítalo Ribeiro Lemes
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, Brazil
| | - Rafael Pires da Silva
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, Brazil
| | - Ana Jéssica Pinto
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, Brazil.,Division of Endocrinology, Metabolism, and Diabetes and Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bruna Caruso Mazzolani
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, Brazil
| | - Fabiana Infante Smaira
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, Brazil
| | | | - Nádia Emi Aikawa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Sandra Pasoto
- Rheumatology Division, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Cristina Medeiros-Ribeiro
- Rheumatology Division, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Carla Saad
- Rheumatology Division, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Emily Yuk
- Rheumatology Division, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Clovis Silva
- Rheumatology Division, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.,Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Pedro Curi Hallal
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Hamilton Roschel
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
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Scognamiglio Renner Araujo C, Medeiros Ribeiro AC, Saad C, Bonfiglioli K, Domiciano DS, Yukie Shimabuco A, Rodrigues Silva M, Neves E, Pasoto S, Pedrosa T, Kanda Kupa L, Zou G, Pereira RM, Silva CA, Aikawa N, Bonfa E. POS0259 A RANDOMIZED CLINICAL TRIAL OF 2-WEEK METHOTREXATE DISCONTINUATION IN RHEUMATOID ARTHRITIS PATIENTS VACCINATED WITH INACTIVATED SARS-COV-2 VACCINE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPatients with rheumatoid arthritis (RA) on methotrexate have reduced vaccine responses. Temporary discontinuation has improved immunogenicity of anti-influenza vaccine, but this strategy has not been evaluated in anti-SARS-CoV-2 vaccines.ObjectivesTo evaluate the effect on immunogenicity and safety of 2-week methotrexate (MTX) discontinuation after each dose of the Sinovac-CoronaVac vaccine versus MTX maintenance in rheumatoid arthritis (RA) patients.MethodsThis was a single-center, prospective, randomized, investigator-blinded, intervention study (#NCT04754698, CoronavRheum), including adult RA patients (stable CDAI≤10, prednisone ≤7.5mg/day), randomized (1:1) to withdraw MTX (MTX-hold) for 2 weeks after each vaccine dose or maintain MTX (MTX-maintain), evaluated at D0, D28 and D69. Co-primary outcomes were anti-SARS-CoV-2 S1/S2 IgG seroconversion(SC) and neutralizing antibody (NAb) positivity at D69. Secondary outcomes were geometric mean titers (GMT) and flare rates. For immunogenicity analyses, we excluded patients with baseline positive IgG/NAb, and, for safety reasons, those who flared at D28 (CDAI>10) and did not withdraw MTX twice.ResultsRandomization included 138 patients with 9 exclusions (5 COVID-19, 4 protocol violations). Safety evaluation included 60 (MTX-hold) and 69 (MTX-maintain) patients. Further exclusions: 27 patients [13 (21.7%) vs. 14 (20.3%), p=0.848] with positive baseline IgG/NAb and 10 patients (21.3%) in MTX-hold with CDAI>10 at D28. At D69, MTX-hold (n=37) had a higher rate of seroconversion than MTX-maintain (n=55) group [29 (78.4%) vs 30 (54.5%), p=0.019], with parallel augmentation in GMT [34.2 (25.2-46.4) vs 16.8 (11.9-23.6), p=0.006]. No differences were observed for NAb positivity [23 (62.2%) vs 27 (49.1%), p=0.217]. At D28 flare, rates were comparable in both groups (CDAI, p=0.122; DAS28-CRP, p=0.576), whereas CDAI>10 was more frequent in MTX-hold at D69 (p=0.024).Figure 1.ConclusionWe provide novel data that 2-week MTX withdrawal after each Sinovac-CoronaVac vaccine dose improves anti-SARS-CoV-2 IgG response. The increased flare rates after second MTX withdrawal may be attributed to the short-term interval between vaccine doses. This strategy requires close surveillance and shared decision making due to the possibility of flares.References[1]Jara A, Undurraga EA, González C, et al. Effectiveness of an inactivated SARS-CoV-2 vaccine in Chile. N Eng J Med. 2021 Sep 2;385(10):875-84. doi: 10.1056/NEJMoa2107715[2]Furer V, Eviatar T, Zisman D, et al. Lb0003 Immunogenicity and Safety of the BNT162B2 mRNA Covid-19 Vaccine in Adult Patients with Autoimmune Inflammatory Rheumatic Diseases and General Population: a Multicenter Study. Ann Rheum Dis. 2021;80:200-201. doi: 10.1136/annrheumdis-2021-220647[3]Medeiros-Ribeiro AC, Aikawa NE, Saad CG, et al. Immunogenicity and safety of the CoronaVac inactivated vaccine in patients with autoimmune rheumatic diseases: a phase 4 trial. Nat. Med. 2021 Jul 30:1-8. doi: 10.1038/s41591-021-01469-5.[4]Park JK, Lee MA, Lee EY, et al. Effect of methotrexate discontinuation on efficacy of seasonal influenza vaccination in patients with rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis. 2017 Sep 1;76(9):1559-65. http://dx.doi.org/10.1136/annrheumdis-2017-211128[5]Park JK, Lee YJ, Shin K, et al. Impact of temporary methotrexate discontinuation for 2 weeks on immunogenicity of seasonal influenza vaccination in patients with rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis. 2018 Jun 1;77(6):898-904. http://dx.doi.org/10.1136/annrheumdis-2018-213222AcknowledgementsThis protocol is part of a larger study of immunosuppressed patients with ARD (Clinicaltrials.gov#NCT04754698)Disclosure of InterestsNone declared
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Saad C, Rodrigues Silva M, Degrava Sampaio-Barros P, Moraes J, Goldenstein-Schainberg C, Aikawa N, Neves E, Pasoto S, Pedrosa T, Kenji Aoyama R, Scognamiglio Renner Araujo C, Silva C, Medeiros Ribeiro AC, Bonfa E. AB1192 SARS-COV-2 VACCINE IN SPONDYLOARTHRITIS PATIENTS: OVERALL MODERATE/HIGH IMMUNOGENICITY IMPAIRED BY IMMUNOSUPPRESSANTS AND BIOLOGICAL THERAPY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundWe recently reported an attenuate immunogenicity in patients with autoimmune rheumatic diseases. However, the effect of spondyloarthritis (SpA) and its treatment on COVID-19 vaccine immunogenicity remains to be determined for this group of patients. We therefore aimed to evaluate humoral immune responses to inactivated SARS-CoV-2 vaccine (CoronaVac) in patients with SpA (axial spondyloarthritis and psoriatic arthritis) taking DMARDs and commonly used targeted biological therapies, compared with a control group(CG).ObjectivesEvaluate immunogenicity and safety of CORONAVAC (Sninovac, Beijing) in Spondyloarthritis (SpA) patients.MethodsProspective observational cohort patients diagnosed with 194 SpA and 183 CG were vaccinated with CoronaVac in two doses with a 28-days interval. 194 patients completed the study and could be paired with CG for immunogenicity analysis. Blood samples were collected in the days 0, 28 and 69 (D69) to evaluate anti-SARS-CoV-2 IgG seroconversion(SC) and presence of neutralizing antibodies (NAb) in participants with negative IgG and NAb at baseline.ResultsPatients and GC were comparable regarding age (p=0.93) and sex (p=1.00). Immunogenicity at D69 showed a moderate/high SC (80.2% vs. 95.7%, p<0.0001) and Nab positivity (61.6% vs. 82.7%, p<0.0001) in SpA but lower than CG. Factors associated with lower immunogenicity were older age (56.8 vs. 51.4;p=0.03318) and higher frequencies of prednisone (25.7% vs 4.2%; p=0.0004), methotrexate (51.4% vs 40.1%, p=0.0016) and TNF inhibitor (TNFi) (62.9% vs 34.5%, p=0.0035). Likewise, prednisone (17.6% vs. 2.8%, p=0.0013) and TNFi (50% vs 33.9%; p=0.0408) were associated with diminished NAb positivity. Sulfasalazine was associated with higher SC rates (8.6% vs. 26.8%, p=0.0246) and NAb positivity (13.2% vs. 29.4%, p=0.0168). The multivariate analysis revealed that older age (p=0.037), prednisone (p=0.001), TNFi (p=0.016), and methotrexate(p=0.017) were independently associated with lower SC while prednisone (p=0.006) and TNFi (p=0.027) were also associated with reduced NAb response.ConclusionOur finding of an excellent safety and moderate/high SC rate in SpA supports the recommendation of CoronaVac vaccination. The impaired immune response in the minority of patients under immunosuppressive and biological therapy requires novel strategies to enhance antibody response in this subgroup of patients.References[1]Weaver A, Troum O, Hooper M, Koenig AS, Chaudhari S, Feng J, et al. Rheumatoid arthritis disease activity and disability affect the risk of serious infection events in RADIUS 1. J Rheumatol 2013;40:1275–81.[2]Germano V, Cattaruzza MS, Osborn J, Tarantino A, Di Rosa R, Salemi S, et al. Infection risk in rheumatoid arthritis and spondyloarthropathy patients under treatment with DMARDs, corticosteroids and TNF-alpha antagonists. J Transl Med 2014;12:77.[3]van Assen S, Agmon-Levin N, Elkayam O, Cervera R, Doran MF, Dougados M, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2011;70:414–22.[4]WHO. Coronavirus disease (COVID-19) situation report - 36. Geneva: World Health Organization,2021.https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---27-april-2021 (accessed Nov 28, 2021).[5]Sanche S, Lin YT, Xu C, Romero-Severson E, Hengartner N, Ke R. High contagiousness and rapid spread of severe acute respiratory syndrome coronavirus 2. Emerg Infect Dis 2020; 26: 1470–77.]Disclosure of InterestsNone declared
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Aikawa NE, Kupa LVK, Silva CA, Saad CGS, Pasoto SG, Yuki EFN, Fusco SRG, Shinjo SK, Andrade DCO, Sampaio-Barros PD, Pereira RMR, Chasin ACS, Shimabuco AY, Luppino-Assad AP, Leon EP, Lopes MH, Antonangelo L, Medeiros-Ribeiro AC, Bonfa E. Strong response after fourth dose of mRNA COVID-19 vaccine in autoimmune rheumatic diseases patients with poor response to inactivated vaccine. Rheumatology (Oxford) 2022; 62:480-485. [PMID: 35639644 PMCID: PMC9213862 DOI: 10.1093/rheumatology/keac301] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To assess immunogenicity of a heterologous fourth dose of an mRNA (BNT162b2) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in autoimmune rheumatic diseases (ARD) patients with poor/non-response to inactivated vaccine (Sinovac-CoronaVac). METHODS A total of 164 ARD patients who were coronavirus disease 2019 (COVID-19) poor/non-responders (negative anti-SARS-CoV-2 S1/S2 IgG and/or neutralizing antibodies-NAb) to the third dose of Sinovac-CoronaVac received an additional heterologous dose of mRNA (BNT162b2) 3 months after last dose. IgG and NAb were evaluated before and after the fourth dose. RESULTS Significant increases were observed after the fourth dose in IgG (66.4 vs 95.1%, P < 0.001), NAb positivity (5.5 vs 83.5%, P < 0.001) and geometric mean titre (29.5 vs 215.8 AU/ml, P < 0.001), and 28 (17.1%) remained poor/non-responders. Patients with negative IgG after a fourth dose were more frequently under rituximab (P = 0.001). Negative NAb was associated with older age (P = 0.015), RA (P = 0.002), SSc (P = 0.026), LEF (P = 0.016) and rituximab use (P = 0.007). In multiple logistic regression analysis, prednisone dose ≥7.5 mg/day (OR = 0.34; P = 0.047), LEF (OR = 0.32, P = 0.036) and rituximab use (OR = 0.19, P = 0.022) were independently associated with negative NAb after the fourth vaccine dose. CONCLUSIONS This is the largest study to provide evidence of a remarkable humoral response after the fourth dose of heterologous mRNA SARS-CoV-2 vaccination in ARD patients with poor/non-response to the third dose of an inactivated vaccine. We further identified that treatment, particularly rituximab and prednisone, impaired antibody response to this additional dose. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, CoronavRheum #NCT04754698.
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Affiliation(s)
| | | | - Clovis A Silva
- Division of Rheumatology,Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Leila Antonangelo
- Central Laboratory Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Eloisa Bonfa
- Division of Rheumatology,Correspondence to: Eloisa Bonfa, Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, sala 3190 - Cerqueira César, São Paulo, SP 01246-903, Brazil. E-mail:
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Lang MG, Vinagre CG, Bonfa E, Freitas FR, Pasoto SG, Brito TS, Seguro LP, Maranhão RC, Borba EF. Hydroxychloroquine increased cholesterol transfer to high-density lipoprotein in systemic lupus erythematosus: A possible mechanism for the reversal of atherosclerosis in the disease. Lupus 2022; 31:659-665. [PMID: 35332823 DOI: 10.1177/09612033221090127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The beneficial effect of hydroxychloroquine (HCQ) in decreasing LDL levels on Systemic Lupus Erythematosus (SLE) is well defined. The influence of this drug on HDL levels is still under debate and information about its effect on cholesterol reverse transport is lacking. OBJECTIVE To evaluate the effects of HCQ on HDL levels and the transfer of lipids to this lipoprotein in SLE. METHODS Nineteen SLE patients using only HCQ (SLE WITH HCQ), 19 SLE patients without any therapy (SLE WITHOUT THERAPY), and 19 healthy controls (CONTROL) were included. All three groups were premenopausal women age- and gender-matched. Serum lipids and apolipoproteins were determined by commercial kits. An in vitro transfer of four lipids (14C-Phospolipid, 3H-Cholesteryl ester, 3H-Triglyceride, and 14C-Unesterified cholesterol) from a radioactively labeled nanoemulsion donor to HDL was performed in all participants. RESULTS Groups had comparable mean age, weight, height, BMI(body mass index), and waist circumference (p > .05). Mean HDL levels were higher in SLE WITH HCQ group compared to SLE WITHOUT THERAPY(58.37 ± 14.04 vs 49.79 ± 8.0 mg/dL; p < .05) but lower than CONTROL (58.37 ± 14.04 vs 68.58 ± 9.99 mg/dL; p < .05). Total cholesterol (TC) and LDL levels were also significantly lower in SLE WITH HCQ compared SLE WITHOUT THERAPY(148.16 ± 16.43 vs 167.11 ± 30.18 mg/dL; p < .05, 75.05 ± 22.52 vs 96.05 ± 25.63 mg/dL; p < .05) and CONTROL (148.16 ± 16.43 vs 174.11 ± 23.70 mg/dL; p < .05, 75.05 ± 22.52 vs 88.53 ± 20.24 mg/dL; p < .05). The in vitro lipid transfer to HDL study revealed a significant difference among the three groups (p = .002) with a higher transfer of unesterified cholesterol(UC) in SLE WITH HCQ compared to SLE WITHOUT THERAPY(5.40 ± 1.05% vs. 4.44 ± 1.05%; p < .05). The latter was significantly decreased compared to CONTROL (5.40 ± 1.05% vs. 5.99 ± 1.71%; p < .05).The percentages of transfer of triacylglycerol (4.93 ± 0.69% vs. 4.50 ± 0.69% vs. 5.14 ± 1.01%; p = .054), esterified cholesterol (5.24 ± 0.70% vs. 4.96 ± 0.89% vs. 5.69 ± 1.27%; p = .079), and phospholipid (15.67 ± 1.03% vs. 15.34 ± 1.44% vs. 16.47 ± 1.89%; p = .066) were similar among groups. CONCLUSION The present study is the first to demonstrate that HCQ promoted a higher transfer of unesterified cholesterol which may account for the increased HDL levels in lupus patients under HCQ. This desirable effect may underlie the reported reduced atherosclerosis in SLE.
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Affiliation(s)
- Maria G Lang
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, 117265Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carmen Gc Vinagre
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, 117265Universidade de Sao Paulo, Sao Paulo, Brazil.,Universidade Santo Amaro (UNISA), Sao Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, 117265Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fatima R Freitas
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, 117265Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, 117265Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tatiane S Brito
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, 117265Universidade de Sao Paulo, Sao Paulo, Brazil.,Universidade Santo Amaro (UNISA), Sao Paulo, Brazil
| | - Luciana Pc Seguro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, 117265Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Raul C Maranhão
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, 117265Universidade de Sao Paulo, Sao Paulo, Brazil.,Faculdade de Ciencias Farmaceuticas, 117265Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eduardo F Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, 117265Universidade de Sao Paulo, Sao Paulo, Brazil
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Pasoto SG, Halpern ASR, Guedes LKN, Ribeiro ACM, Yuki ENF, Saad CGS, da Silva CAA, de Vinci Kanda Kupa L, Villamarín LEB, de Oliveira Martins VA, Martins CCMF, Deveza GBH, Leon EP, Bueno C, Pedrosa TN, Santos REB, Soares R, Aikawa NE, Bonfa E. Inactivated SARS-CoV-2 vaccine in primary Sjögren’s syndrome: humoral response, safety, and effects on disease activity. Clin Rheumatol 2022; 41:2079-2089. [PMID: 35306594 PMCID: PMC8934123 DOI: 10.1007/s10067-022-06134-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 12/02/2022]
Abstract
Introduction There is no study specifically focused on SARS-CoV-2 vaccine in primary Sjögren’s syndrome (pSS). Objectives To assess the immunogenicity, safety, possible effects on disease activity, and autoantibody profile of the Sinovac-CoronaVac vaccine in pSS. Methods Fifty-one pSS patients and 102 sex- and age-balanced controls without autoimmune diseases were included in a prospective phase 4 trial of the Sinovac-CoronaVac vaccine (two doses 28 days apart, D0/D28). Participants were assessed in three face-to-face visits (D0/D28 and six weeks after the 2nd dose (D69)) regarding adverse effects; clinical EULAR Sjögren’s Syndrome Disease Activity Index (clinESSDAI); anti-SARS-CoV-2 S1/S2 IgG (seroconversion (SC) and geometric mean titers (GMT)); neutralizing antibodies (NAb); and pSS autoantibody profile. Results Patients and controls had comparable female sex frequency (98.0% vs. 98.0%, p = 1.000) and mean age (53.5 ± 11.7 vs. 53.4 ± 11.4 years, p = 0.924), respectively. On D69, pSS patients presented moderate SC (67.5% vs. 93.0%, p < 0.001) and GMT (22.5 (95% CI 14.6–34.5) vs. 59.6 (95% CI 51.1–69.4) AU/mL, p < 0.001) of anti-SARS-CoV-2 S1/S2 IgG but lower than controls, and also, moderate NAb frequency (52.5% vs. 73.3%, p = 0.021) but lower than controls. Median neutralizing activity on D69 was comparable in pSS (58.6% (IQR 43.7–63.6)) and controls (64% (IQR 46.4–81.1)) (p = 0.219). Adverse events were mild. clinESSDAI and anti-Ro(SS-A)/anti-La(SS-B) levels were stable throughout the study (p > 0.05). Conclusion Sinovac-CoronaVac vaccine is safe in pSS, without a deleterious impact on disease activity, and has a moderate short-term humoral response, though lower than controls. Thus, a booster dose needs to be studied in these patients. Trial registration ClinicalTrials.gov Identifier: NCT04754698.Key Points • Sinovac-CoronaVac vaccine is safe in pSS, without a detrimental effect on systemic disease activity, and has a moderate short-term humoral response • A booster doseshould be considered in these patients |
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Affiliation(s)
- Sandra Gofinet Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil.
| | - Ari Stiel Radu Halpern
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Lissiane Karine Noronha Guedes
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Ana Cristina Medeiros Ribeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Emily Neves Figueiredo Yuki
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Carla Gonçalves Schahin Saad
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Clovis Artur Almeida da Silva
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Léonard de Vinci Kanda Kupa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Lorena Elizabeth Betancourt Villamarín
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Victor Adriano de Oliveira Martins
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Carolina Campagnoli Machado Freire Martins
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Giordano Bruno Henriques Deveza
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Elaine Pires Leon
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Cleonice Bueno
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Tatiana Nascimento Pedrosa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Roseli Eliana Beseggio Santos
- Central Laboratory Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Renata Soares
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Nádia Emi Aikawa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3190, Sao Paulo, SP, 01246-903, Brazil
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Aikawa NE, Kupa LDVK, Medeiros-Ribeiro AC, Saad CGS, Yuki EFN, Pasoto SG, Rojo PT, Pereira RMR, Shinjo SK, Sampaio-Barros PD, Andrade DCO, Halpern ASR, Fuller R, Souza FHC, Guedes LKN, Assad APL, Moraes JCBD, Lopes MRU, Martins VADO, Betancourt L, Ribeiro CT, Sales LP, Bertoglio IM, Bonoldi VLN, Mello RLP, Balbi GGM, Sartori AMC, Antonangelo L, Silva CA, Bonfa E. Increment of immunogenicity after third dose of a homologous inactivated SARS-CoV-2 vaccine in a large population of patients with autoimmune rheumatic diseases. Ann Rheum Dis 2022; 81:1036-1043. [DOI: 10.1136/annrheumdis-2021-222096] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/28/2022] [Indexed: 01/11/2023]
Abstract
ObjectiveTo determine the immunogenicity of the third dose of CoronaVac vaccine in a large population of patients with autoimmune rheumatic diseases (ARD) and the factors associated with impaired response.MethodsAdult patients with ARD and age-balanced/sex-balanced controls (control group, CG) previously vaccinated with two doses of CoronaVac received the third dose at D210 (6 months after the second dose). The presence of anti-SARS-CoV-2 S1/S2 IgG and neutralising antibodies (NAb) was evaluated previously to vaccination (D210) and 30 days later (D240). Patients with controlled disease suspended mycophenolate mofetil (MMF) for 7 days or methotrexate (MTX) for 2 weekly doses after vaccination.ResultsARD (n=597) and CG (n=199) had comparable age (p=0.943). Anti-S1/S2 IgG seropositivity rates significantly increased from D210 (60%) to D240 (93%) (p<0.0001) in patients with ARD. NAb positivity also increased: 38% (D210) vs 81.4% (D240) (p<0.0001). The same pattern was observed for CG, with significantly higher frequencies for both parameters at D240 (p<0.05). Multivariate logistic regression analyses in the ARD group revealed that older age (OR=0.98, 95% CI 0.96 to 1.0, p=0.024), vasculitis diagnosis (OR=0.24, 95% CI 0.11 to 0.53, p<0.001), prednisone ≥5 mg/day (OR=0.46, 95% CI 0.27 to 0.77, p=0.003), MMF (OR=0.30, 95% CI 0.15 to 0.61, p<0.001) and biologics (OR=0.27, 95% CI 0.16 to 0.46, p<0.001) were associated with reduced anti-S1/S2 IgG positivity. Similar analyses demonstrated that prednisone ≥5 mg/day (OR=0.63, 95% CI 0.44 to 0.90, p=0.011), abatacept (OR=0.39, 95% CI 0.20 to 0.74, p=0.004), belimumab (OR=0.29, 95% CI 0.13 to 0.67, p=0.004) and rituximab (OR=0.11, 95% CI 0.04 to 0.30, p<0.001) were negatively associated with NAb positivity. Further evaluation of COVID-19 seronegative ARD at D210 demonstrated prominent increases in positivity rates at D240 for anti-S1/S2 IgG (80.5%) and NAb (59.1%) (p<0.0001).ConclusionsWe provide novel data on a robust response to the third dose of CoronaVac in patients with ARD, even in those with prevaccination COVID-19 seronegative status. Drugs implicated in reducing immunogenicity after the regular two-dose regimen were associated with non-responsiveness after the third dose, except for MTX.Trial registration numberNCT04754698.
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20
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Netto LC, Ibrahim KY, Picone CM, Alves APPS, Aniceto EV, Santiago MR, Parmejani PSS, Aikawa NE, Medeiros-Ribeiro AC, Pasoto SG, Yuki EFN, Saad CGS, Pedrosa T, Lara AN, Ceneviva C, Bonfa E, Kallas EG, Avelino-Silva VI. Safety and immunogenicity of CoronaVac in people living with HIV: a prospective cohort study. The Lancet HIV 2022; 9:e323-e331. [PMID: 35338835 PMCID: PMC8942475 DOI: 10.1016/s2352-3018(22)00033-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 12/14/2022]
Abstract
Background People living with HIV might have a poor or delayed response to vaccines, mainly when CD4 cell counts are low, and data concerning COVID-19 vaccines in this population are scarce. This prospective cohort study assessed the safety and immunogenicity of the inactivated SARS-CoV-2 vaccine CoronaVac in people with HIV compared with people with no known immunosuppression. Methods In this prospective cohort study, adults (aged ≥18 years) living with HIV who were regularly followed up at the University of Sao Paulo HIV/AIDS outpatient clinic in Sao Paulo, Brazil, were included in the study. Eligibility for people with HIV was independent of antiretroviral use, HIV viral load, or CD4 cell count. Adults with no known immunosuppression with CoronaVac vaccination history were included as a control group. CoronaVac was given intramuscularly in a two-dose regimen, 28 days apart. Blood was collected before vaccine administration and 6 weeks after the second dose (day 69). Immunogenicity was assessed at baseline (day 0), before second vaccine (day 28), and 6 weeks after second vaccine dose (day 69) through SARS-CoV-2 IgG titre and seroconversion, neutralising antibody (NAb) positivity and percentage activity, and factor increase in IgG geometric mean titres (FI-GMT). We investigated whether HIV status and CD4 count (<500 or ≥500 cells per μL) were associated with CoronaVac immunogenicity by use of multivariable models adjusted for age and sex. Findings Between Feb 9, 2021, and March 4, 2021, 776 participants were recruited. Of 511 participants included, 215 (42%) were people with HIV and 296 (58%) were people with no known immunosuppression. At 6 weeks after the second vaccine dose (day 69), 185 (91%) of 204 participants with HIV and 265 (97%) of 274 participants with no known immunosuppression had seroconversion (p=0·0055). 143 (71%) of 202 participants with HIV were NAb positive compared with 229 (84%) of 274 participants with no known immunosuppression (p=0·0008). Median IgG titres were 48·7 AU/mL (IQR 26·6–88·2) in people with HIV compared with 75·2 AU/mL (50·3–112·0) in people with no known immunosuppression (p<0·0001); and median NAb activity was 46·2% (26·9–69·7) compared with 60·8% (39·8–79·9; p<0·0001). In people with HIV who had CD4 counts less than 500 cells per μL seroconversion rates, NAb positivity, and NAb activity were lower than in those with CD4 counts of at least 500 cells per μL. In multivariable models for seroconversion, NAb positivity, IgG concentration, and NAb activity after a complete two-dose regimen, adjusted for age and sex, people with HIV who had CD4 counts of at least 500 cells per μL and people with no known immunosuppression had higher immunogenicity than did people with HIV with CD4 counts less than 500 cells per μL. No serious adverse reactions were reported during the study. Interpretation Immunogenicity following CoronaVac in people with HIV seems strong but reduced compared with people with no known immunosuppression. Our findings highlight the need for strategies to improve vaccine immunogenicity in people with HIV. Funding Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), and B3—Bolsa de Valores do Brasil.
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21
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Gualano B, Lemes IR, Silva RP, Pinto AJ, Mazzolani BC, Smaira FI, Sieczkowska SM, Aikawa NE, Pasoto SG, Medeiros-Ribeiro AC, Saad CG, Yuki EF, Silva CA, Swinton P, Hallal PC, Roschel H, Bonfa E. Association between physical activity and immunogenicity of an inactivated virus vaccine against SARS-CoV-2 in patients with autoimmune rheumatic diseases. Brain Behav Immun 2022; 101:49-56. [PMID: 34954325 PMCID: PMC8697420 DOI: 10.1016/j.bbi.2021.12.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/10/2021] [Accepted: 12/18/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To investigate whether physical activity is associated with enhanced immunogenicity of a SARS-CoV-2 inactivated vaccine (Coronavac) in patients with autoimmune rheumatic diseases (ARD) (n = 898) and in non-ARD (n = 197) individuals without pre-existing immunogenicity to SARS-CoV-2. METHODS This was a prospective cohort study within an open-label, single-arm, phase 4 vaccination trial. Immunogenicity was assessed after vaccination by measuring seroconversion rates of total anti-SARS-CoV-2 S1/S2 IgG (SC), geometric mean titers of anti-S1/S2 IgG (GMT), factor-increase in GMT (FI-GMT), frequency of neutralizing antibody (NAb), and median neutralizing activity. Physical activity (active being defined as ≥ 150 min/week) and sedentary behavior (>8h/day) were assessed by questionnaire. RESULTS Physically active ARD patients (n = 494) were younger and less frequently used prednisone/biologics than inactive patients (n = 404). After controlling for covariates, active patients exhibited greater SC (OR: 1.4 [95%CI: 1.1-2.0]), GMT (32% [95%CI: 8.8-60) and FI-GMT (33% [95%CI: 9.6-63%]) vs. inactive. Cluster analysis (physical activity/sedentary status) revealed greater GMT (43.0% [95% CI: 11.0-84.0%) and FI-GMT (48.0% [95%CI: 14.0-92.0%]) in active/non-sedentary vs. inactive/sedentary ARD patients. A dose-response was observed, with greater benefits for the group of patients performing ≥ 350 min/week of physical activity (OR: 1.6 [95%CI: 1.1-2.4]; 41% [95%CI: 10-80%]; 35% [95%CI: 4.3-74], for SC, GMT, and FI-GMT, respectively) vs. the least active group (≤30 min/week). Greater SC (OR: 9.9 [95%CI: 1.1-89.0]) and GMT (26% [95%CI: 2.2-56.0%]) were observed in active vs. inactive non-ARD. CONCLUSIONS A physically active lifestyle may enhance SARS-CoV-2 vaccine immunogenicity, a finding of particular clinical relevance for immunocompromised patients. TRIAL REGISTRATION Clinicaltrials.gov #NCT04754698.
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Affiliation(s)
- Bruno Gualano
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, Brazil; Food Research Center, University of São Paulo, Sao Paulo, Brazil.
| | - Italo R. Lemes
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, Brazil
| | - Rafael P. Silva
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, Brazil
| | - Ana J. Pinto
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, Brazil,Division of Endocrinology, Metabolism, and Diabetes and Anschutz Health and Wellness Center, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Bruna C. Mazzolani
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, Brazil
| | - Fabiana I. Smaira
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, Brazil
| | - Sofia M. Sieczkowska
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, Brazil
| | - Nadia E. Aikawa
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra G. Pasoto
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana C. Medeiros-Ribeiro
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carla G.S. Saad
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Emily F.N. Yuki
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Clovis A. Silva
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil,Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paul Swinton
- Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Pedro C. Hallal
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Hamilton Roschel
- Applied Physiology & Nutrition Research Group, University of São Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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22
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Drenkard C, Fuentes-Silva Y, Parente Costa Seguro L, Torres dos Reis-Neto E, Ibañez S, Elera-Fitzcarrald C, Reategui-Sokolova C, Linhares FA, Bermúdez W, Ferreyra-Garrot L, Acosta C, Caballero-Uribe CV, Sato EI, Bonfa E, Pons-Estel BA. Let's Talk About Lupus. Overview of an Innovative, High-Reach, Online Program to Fill the Education Gaps of Latin Americans Living With Lupus. J Clin Rheumatol 2022; 28:e368-e374. [PMID: 34014052 PMCID: PMC8860199 DOI: 10.1097/rhu.0000000000001728] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE The Latin American population living with lupus lacks reliable and culturally competent health education resources. We describe a Spanish and Portuguese online program to educate Latin American people about lupus. METHODS An extensive network of Latin American stakeholders participated in the program design, implementation, dissemination, and evaluation. Patients and rheumatologists selected core topics. Rheumatologists prepared the content using evidence-based data. Adaptations were conducted to meet the audience's health literacy and cultural values. Social media was used to post audiovisual resources and facilitate users' interactions with peers and educators, and a Web site was created to offer in-depth knowledge. RESULTS The most massive outreach was through Facebook, with more than 20 million people reached and 80,000 followers at 3 months, between the Spanish and Portuguese pages. Nearly 90% of followers were from Latin America. A high engagement and positive responses to a satisfaction survey indicate that Facebook users valued these resources. The Spanish and Portuguese Web sites accumulated more than 62,000 page views, and 71.7% of viewers were from Latin American. CONCLUSIONS The engagement of patients and stakeholders is critical to provide and disseminate reliable lupus education. Social media can be used to educate and facilitate interactions between people affected by lupus and qualified health care professionals. Social media-based health education has extensive and scalable outreach but is more taxing for the professional team than the Web site. However, the Web site is less likely to be used as a primary education source by Latin American people because they value social interactions when seeking lupus information.
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Affiliation(s)
- Cristina Drenkard
- From the Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | | | - Carlota Acosta
- Hospital Universitario “Ruiz y Paez,” Ciudad Bolivar, Venezuela
| | | | - Emilia Inoue Sato
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo
| | - Bernardo A. Pons-Estel
- Grupo Oroño. Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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23
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Araujo CSR, Medeiros-Ribeiro AC, Saad CGS, Bonfiglioli KR, Domiciano DS, Shimabuco AY, Silva MSR, Yuki EFN, Pasoto SG, Pedrosa T, Kupa LDVK, Zou G, Pereira RMR, Silva CA, Aikawa NE, Bonfa E. Two-week methotrexate discontinuation in patients with rheumatoid arthritis vaccinated with inactivated SARS-CoV-2 vaccine: a randomised clinical trial. Ann Rheum Dis 2022; 81:889-897. [PMID: 35193873 DOI: 10.1136/annrheumdis-2021-221916] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/07/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the effect on immunogenicity and safety of 2-week methotrexate (MTX) discontinuation after each dose of the Sinovac-CoronaVac vaccine versus MTX maintenance in patients with rheumatoid arthritis (RA). METHODS This was a single-centre, prospective, randomised, investigator-blinded, intervention study (NCT04754698, CoronavRheum) including adult patients with RA (stable Clinical Disease Activity Index (CDAI) ≤10, prednisone ≤7.5 mg/day) randomised (1:1) to withdraw MTX (MTX-hold) for 2 weeks after each vaccine dose or maintain MTX (MTX-maintain), evaluated at day 0 (D0), D28 and D69. Coprimary outcomes were anti-SARS-CoV-2 S1/S2 IgG seroconversion (SC) and neutralising antibody (NAb) positivity at D69. Secondary outcomes were geometric mean titres (GMT) and flare rates. For immunogenicity analyses, we excluded patients with baseline positive IgG/NAb, and for safety reasons those who flared at D28 (CDAI >10) and did not withdraw MTX twice. RESULTS Randomisation included 138 patients with 9 exclusions (5 COVID-19, 4 protocol violations). Safety evaluation included 60 patients in the MTX-hold and 69 patients in the MTX-maintain group. Further exclusions included 27 patients (13 (21.7%) vs 14 (20.3%), p=0.848) with positive baseline IgG/NAb and 10 patients (21.3%) in MTX-hold with CDAI >10 at D28. At D69, the MTX-hold group (n=37) had a higher rate of SC than the MTX-maintain group (n=55) (29 (78.4%) vs 30 (54.5%), p=0.019), with parallel augmentation in GMT (34.2 (25.2-46.4) vs 16.8 (11.9-23.6), p=0.006). No differences were observed for NAb positivity (23 (62.2%) vs 27 (49.1%), p=0.217). At D28 flare, the rates were comparable in both groups (CDAI, p=0.122; Disease Activity Score in 28 joints with C reactive protein, p=0.576), whereas CDAI >10 was more frequent in MTX-hold at D69 (p=0.024). CONCLUSION We provided novel data that 2-week MTX withdrawal after each dose of the Sinovac-CoronaVac vaccine improves anti-SARS-CoV-2 IgG response. The increased flare rates after the second MTX withdrawal may be attributed to the short-term interval between vaccine doses. This strategy requires close surveillance and shared decision making due to the possibility of flares.
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Affiliation(s)
| | | | - Carla G S Saad
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Karina Rossi Bonfiglioli
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Diogo Souza Domiciano
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Andrea Yukie Shimabuco
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | | | | | - Sandra Gofinet Pasoto
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Tatiana Pedrosa
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | | | - Gioanna Zou
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Rosa M R Pereira
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Clóvis Artur Silva
- Pediatric Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Nádia Emi Aikawa
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
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Gualano B, Saad CGS, Sieczkowska SM, Lemes IR, da Silva RP, Pinto AJ, Mazzolani BC, Smaira FI, Gil S, de Oliveira Júnior GN, Aikawa NE, Ribeiro ACM, Silva CA, Yuki EFN, Pasoto SG, Rodrigues Pereira RM, Shinjo SK, de Andrade DCO, Sampaio-Barros PD, Roschel H, Bonfa E. Effect of an Exercise Bout Prior to the Booster Dose of an Inactivated SARS-CoV-2 Vaccine on Immunogenicity in Immunocompromised Patients. J Appl Physiol (1985) 2022; 132:682-688. [PMID: 35142560 PMCID: PMC8897009 DOI: 10.1152/japplphysiol.00015.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This randomized controlled study aimed to investigate whether a single bout of exercise before the homologous booster dose of a SARS-CoV-2 inactivated vaccine could enhance immunogenicity in patients with spondyloarthritis. We selected 60 consecutive patients with spondyloarthritis (SpA). Patients assigned to the intervention group performed an exercise bout comprising three exercises. Then, they remained at rest for 1 h before vaccination. The control group remained at rest before vaccination. Immunogenicity was assessed before (Pre) and 1 mo after (Post) the booster using seropositivity rates of total anti-SARS-CoV-2 S1/S2 IgG, geometric mean titers of anti-S1/S2 IgG (GMT), frequency of neutralizing antibodies (NAb) positivity, and NAb activity. At Pre, 16 patients from the exercise group and 16 patients from the control group exhibited seropositivity for IgG (59% vs. 57.1%), and 1 mo after the booster dose, seropositivity occurred in 96% versus 100% of the cases. Only 10 patients from the exercise group and 12 patients from the control group showed positive NAb serology at Pre (37% vs. 42.8%). One month following the booster, NAb positivity was 96% versus 93%. GMT was comparable between groups at Pre. At Post, GMT increased similarly in both groups. Likewise, NAb activity was similar between groups at Pre and increased similarly in both of them as a result of the booster (47.5% vs. 39.9%). In conclusion, a single bout of exercise did not enhance immunogenicity to a homologous booster dose of an inactivated SARS-CoV-2 vaccine among patients with spondyloarthritis. NEW & NOTEWORTHY We tested the role of exercise as an adjuvant to a booster of a COVID-19 vaccine. Immunocompromised patients were immunized after an acute bout of exercise or not. Patients exhibited an excellent immunogenicity in response to the booster dose. Exercise did not add to the vaccine effects on IgG or neutralizing antibodies.
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Affiliation(s)
- Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.,Food Research Center, University of São Paulo, Sao Paulo, Brazil
| | - Carla Golçalves S Saad
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sofia Mendes Sieczkowska
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Italo Ribeiro Lemes
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rafael Pires da Silva
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana J Pinto
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.,Division of Endocrinology, Metabolism, and Diabetes and Anschutz Health and Wellness Center, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Bruna C Mazzolani
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fabiana I Smaira
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Saulo Gil
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Gersiel Nascimento de Oliveira Júnior
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nadia Emi Aikawa
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana Cristina Medeiros Ribeiro
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Clovis Artur Silva
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Emily F N Yuki
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra G Pasoto
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosa Maria Rodrigues Pereira
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Samuel K Shinjo
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Percival D Sampaio-Barros
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfa
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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25
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Medeiros-Ribeiro AC, Bonfiglioli KR, Domiciano DS, Shimabuco AY, da Silva HC, Saad CGS, Yuki EFN, Pasoto SG, Araujo CSR, Nakai TL, Silva CA, Pedrosa T, Kupa LDVK, Silva MSR, Balbi GGM, Kallas EG, Aikawa NE, Bonfa E. Distinct impact of DMARD combination and monotherapy in immunogenicity of an inactivated SARS-CoV-2 vaccine in rheumatoid arthritis. Ann Rheum Dis 2022; 81:710-719. [PMID: 35135832 DOI: 10.1136/annrheumdis-2021-221735] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate the distinct impact of disease modifying antirheumatic drugs (DMARD) combination and monotherapy in immune response to an inactivated SARS-CoV-2 vaccine in patients with rheumatoid arthritis (RA). METHODS This phase 4 prospective study analysed seroconversion (SC) of anti-SARS-CoV-2 immunoglobulin G (IgG) and neutralising antibodies (NAb) induced by the inactivated vaccine (CoronaVac) in patients with RA in comparison to controls (CG). Disease activity and treatment were also assessed. Only participants with baseline negative IgG/NAb were included. RESULTS Patients with RA (N=260) and CG (N=104) had comparable median ages (59 years (50-65 years) vs 58 years (49.8-64 years), p=0.483). Patients with RA had moderate but lower SC (61.8% vs 94.2%, p<0.001) and NAb positivity (45% vs 78.6%, p<0.001) in comparison to CG after full vaccination. Baseline disease activity did not influence immunogenicity (p>0.05). After multivariate analyses, factors independently related to reduced SC were: older age (OR=0.79 (0.70-0.89) for each 5-year interval, p<0.001), methotrexate (OR=0.54 (0.29-0.98), p=0.044), abatacept (OR=0.37 (0.19-0.73), p=0.004) and number of DMARD (OR=0.55 (0.33-0.90), p=0.018). Regarding NAb, age (OR=0.87 (0.78-0.96) for each 5-year interval, p=0.007) and prednisone >7.5 mg/day (OR=0.38 (0.19-0.74), p=0.004) were negatively related to the presence of NAb. Further comparison of SC/NAb positivity among RA treatment subgroups and CG revealed that methotrexate/tofacitinib/abatacept/tocilizumab use, in monotherapy or in combination, resulted in lower responses (p<0.05), while tumour necrosis factor inhibitor and other conventional synthetic DMARD interfered solely when combined with other therapies. CONCLUSIONS Patients with RA under DMARD have a moderate immunogenicity to CoronaVac. We identified that nearly all DMARD combinations have a deleterious effect in immunogenicity, whereas a more restricted number of drugs (methotrexate/tofacitinib/abatacept/tocilizumab) also hampered this response as monotherapy. These findings reinforce the need of a broader approach, not limited to specific drugs, to improve vaccine response for this population. TRIAL REGISTRATION DETAILS NCT04754698.
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Affiliation(s)
| | - Karina Rossi Bonfiglioli
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Diogo Souza Domiciano
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Andrea Yukie Shimabuco
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Henrique Carriço da Silva
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carla G S Saad
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Emily Figueiredo Neves Yuki
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra Gofinet Pasoto
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Tatiane Lie Nakai
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Clóvis Artur Silva
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tatiana Pedrosa
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Léonard de Vinci Kanda Kupa
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Esper Georges Kallas
- Infectious and Parasitic Diseases Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nádia Emi Aikawa
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Aikawa NE, Kupa LVK, Pasoto SG, Medeiros-Ribeiro AC, Yuki EFN, Saad CGS, Pedrosa T, Fuller R, Shinjo SK, Sampaio-Barros PD, Andrade DCO, Pereira RMR, Seguro LPC, Valim JML, Waridel F, Sartori AMC, Duarte AJS, Antonangelo L, Sabino EC, Menezes PR, Kallas EG, Silva CA, Bonfa E. Immunogenicity and safety of two doses of the CoronaVac SARS-CoV-2 vaccine in SARS-CoV-2 seropositive and seronegative patients with autoimmune rheumatic diseases in Brazil: a subgroup analysis of a phase 4 prospective study. The Lancet Rheumatology 2022; 4:e113-e124. [PMID: 34901885 PMCID: PMC8641960 DOI: 10.1016/s2665-9913(21)00327-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background We aimed to examine the immunogenicity pattern induced by the inactivated SARS-CoV-2 vaccine CoronaVac (Sinovac Life Sciences, Beijing, China) in SARS-CoV-2 seropositive patients with autoimmune rheumatic diseases compared with seropositive controls, seronegative patients with autoimmune rheumatic diseases, and seronegative controls. Methods CoronavRheum is an ongoing, prospective, controlled, phase 4 study, in which patients aged 18 years or older with autoimmune rheumatic diseases, and healthy controls were recruited from a single site (Rheumatology Division of Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo) in São Paulo, Brazil Participants were vaccinated with two doses of CoronaVac (intramuscular injection, 3 μg in 0·5 mL of β-propiolactone inactivated SARS-CoV-2) on day 0 and on day 28. Blood samples were taken pre-vaccination on day 0, day 28, and also on day 69. For this subgroup analysis, participants were defined as being SARS-CoV-2 seropositive or seronegative prevaccination via anti-SARS-CoV-2 spike (S)1 or S2 IgG (cutoff of 15·0 arbitrary units [AU] per mL) or neutralising antibody titres (cutoff of ≥30%) and were matched for age and sex, via convenience sampling, in a 1:3:1:1 ratio (seropositive patients to seronegative patients to seropositive controls to seronegative controls). The primary outcomes were rates of anti-SARS-CoV-2 S1 and S2 IgG seropositivity and SARS-CoV-2 neutralising antibody positivity at day 28 and day 69 and immunogenicity dynamics assessed by geometric mean titres (GMTs) of IgG and median neutralising activity in seropositive patients with autoimmune rheumatic diseases compared with seronegative patients and seropositive and seronegative controls. We assessed safety in all participants randomly selected for this subgroup analysis. This study is registered with ClinicalTrials.gov, NCT04754698, and is ongoing for long-term immunogenicity evaluation. Findings Between Feb 4 and Feb 8, 2021, 1418 patients and 542 controls were recruited, of whom 1685 received two vaccinations (1193 patients and 492 controls). After random sampling, our immunogenicity analysis population comprised 942 participants, of whom 157 were SARS-CoV-2 seropositive patients with autoimmune rheumatic diseases, 157 were seropositive controls, 471 were seronegative patients, and 157 were seronegative controls; the median age was 48 years (IQR 38–56) and 594 (63%) were female and 348 (37%) were male. For seropositive patients and controls, an increase in anti-SARS-CoV-2 S1 and S2 IgG titres (seropositive patients GMT 52·3 [95% CI 42·9–63·9] at day 0 vs 128·9 [105·6–157·4] at day 28; seropositive controls 53·3 [45·4–62·5] at day 0 vs 202·0 [174·8–233·4] at day 28) and neutralising antibody activity (seropositive patients 59% [IQR 39–83] at day 0 vs 82% [54–96] at day 28; seropositive controls 58% [41–79] at day 0 vs 92% [79–96] at day 28), was observed from day 0 to day 28, without further increases from day 28 to day 69 (at day 69 seropositive patients' GMT was 137·1 [116·2–161·9] and neutralising antibody activity was 79% [57–94]); and seropositive controls' GMT was 188·6 [167·4–212·6] and neutralising antibody activity was 92% [75–96]). By contrast, for seronegative patients and controls, the second dose was required for maximum response at day 69, which was lower in seronegative patients than in seronegative controls. GMTs in seronegative patients were 2·3 (95% CI 2·2–2·3) at day 0, 5·7 (5·1–6·4) at day 28, and 29·6 (26·4–33·3) at day 69, and in seronegative controls were 2·3 (2·1–2·5) at day 0, 10·6 (8·7–13·1) at day 28, and 71·7 (63·5–81·0) at day 69; neutralising antibody activity in seronegative patients was 15% (IQR 15–15) on day 0, 15% (15–15) at day 28, and 39% (15–65) at day 69, and in seronegative controls was 15% (15–15) at day 0, 24% (15–37) at day 28, and 61% (37–79) at day 69. Neither seronegative patients nor seronegative controls reached the GMT or antibody activity levels of seropositive patients at day 69. Interpretation By contrast with seronegative patients with autoimmune rheumatic diseases, seropositive patients have a robust response after a single dose of CoronaVac. Our findings raise the possibility that the reduced immunogenicity observed in seronegative patients might not be the optimum response potential to SARS-CoV-2 vaccination, and therefore emphasise the importance of at least a single booster vaccination in these patients. Funding Fundação de Amparo à Pesquisa do Estado de São Paulo, Conselho Nacional de Desenvolvimento Científico e Tecnológico, and B3-Bolsa de Valores do Brasil. Translation For the Portuguese translation of the abstract see Supplementary Materials section.
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27
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Yuki EFN, Borba EF, Pasoto SG, Seguro LP, Lopes M, Saad CGS, Medeiros‐Ribeiro AC, Silva CA, de Andrade DCO, Kupa LDVK, Betancourt L, Bertoglio I, Valim J, Hoff C, Formiga FC, Pedrosa T, Kallas EG, Aikawa NE, Bonfa E. Impact of distinct therapies on antibody response to SARS-CoV-2 vaccine in systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2021; 74:562-571. [PMID: 34806342 PMCID: PMC9011410 DOI: 10.1002/acr.24824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/03/2021] [Accepted: 11/18/2021] [Indexed: 11/07/2022]
Abstract
Objective To date, the only study that has assessed the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2 mRNA) vaccine in systemic lupus erythematosus (SLE) observed a moderate response, but the sample size precluded an accurate analysis of the effect of individual drugs. Therefore, we evaluated the immunogenicity of an inactivated SARS‐CoV‐2 vaccine (Sinovac‐CoronaVac) and the influence of different medications in SLE. Safety was also assessed. Methods We conducted a prospective controlled study of 232 SARS‐CoV‐2–naive SLE patients and 58 SARS‐CoV‐2–naive controls who were vaccinated with 2 doses of Sinovac‐CoronaVac with a 28‐day interval (day 0/day 28 [D0/D28]). Immunogenicity analysis at D0/D28 and D69 included anti‐SARS‐CoV‐2 S1/S2 IgG seroconversion (SC) and neutralizing antibodies (NAb) positivity. The influence of individual drugs on immune response and safety was assessed. Results Patients and controls were well balanced for age (P = 0.771). At D69, SLE patients showed a moderate SC (70.2% versus 98.1%; P < 0.001) and moderate frequency of NAb positivity (61.5% versus 84.6%; P = 0.002), although both frequencies were lower than in controls. Factors associated with lower SC in univariate analysis at D69 were prednisone use (odds ratio [OR] 0.215 [95% confidence interval (95% CI) 0.108–0.427], P < 0.001) and mycophenolate mofetil (MMF) use (OR 0.201 [95% CI 0.107–0.378], P < 0.001), whereas hydroxychloroquine (HCQ) use led to a 2.5 increase in SC (P = 0.011). SLE patients who were receiving HCQ monotherapy had similar SC to controls at D69 (100% versus 98.1%; P = 1.000). In multivariate analysis, prednisone and MMF use were independently associated with lower SC (P < 0.001) and NAb positivity (P < 0.001). Safety analysis revealed no moderate/severe adverse events. Conclusion Sinovac‐CoronaVac has a moderate immunogenicity in SARS‐CoV‐2–naive SLE patients with an excellent safety profile. We further demonstrate that HCQ may improve SC, whereas prednisone and MMF had a major deleterious effect in vaccine response, reinforcing the need to investigate the role of temporary MMF withdrawal or a vaccine‐booster dose (ClinicalTrials.gov identifier: NCT04754698).
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Affiliation(s)
- Emily F. N. Yuki
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Eduardo F. Borba
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Sandra G. Pasoto
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Luciana P. Seguro
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Michelle Lopes
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Carla G. S. Saad
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | | | - Clovis A. Silva
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | | | | | - Lorena Betancourt
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Isabela Bertoglio
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Juliana Valim
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Camilla Hoff
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Francisco F. C. Formiga
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Tatiana Pedrosa
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Esper G. Kallas
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Nadia E. Aikawa
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Eloisa Bonfa
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
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28
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Insfrán CE, Aikawa NE, Pasoto SG, Filho DMN, Formiga FFC, Pitta AC, Borba EF, Ribeiro CT, Silva CA, Bonfa E. 2019-EULAR/ACR classification criteria domains at diagnosis: predictive factors of long-term damage in systemic lupus erythematosus. Clin Rheumatol 2021; 41:1079-1085. [PMID: 34782939 DOI: 10.1007/s10067-021-05989-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/09/2021] [Accepted: 11/08/2021] [Indexed: 12/28/2022]
Abstract
The objective of this study is to assess the role of the 2019-European League Against Rheumatism/American College of Rheumatology (2019-EULAR/ACR) classification criteria at diagnosis and its domains in predicting long-term damage in systemic lupus erythematosus(SLE). We performed a retrospective analysis using an electronic chart database utilized in routine clinical care of SLE patients and established in 2000 in a tertiary hospital. Two hundred and nine consecutive SLE patients with disease onset ≥18 years old and long disease duration were included. Cumulative damage at the last visit was scored using the SLICC/ACR-Damage Index (SDI). The median age at SLE diagnosis was 28 years (18-63), disease duration was 14 years (8-25), and 88% were females. Damage (SDI≥1) was observed in 116/209 (55%). Patients with (SDI≥1, n=116) and without damage (SDI=0, n=93) had similar median disease duration [14 (8-25) vs. 12 (8-25) years, p=0.090] and age at diagnosis [23 (18-55) vs. 23 (18-56) years, p=0.998]. No correlation was observed between total 2019-EULAR/ACR score at diagnosis and SDI at last visit (r=0.007, p=0.913). Presence of renal domain at diagnosis was associated with renal damage at last visit (OR=3.6, 95%CI 1.2-10.4, p=0.017) and antiphospholipid antibodies domain predicted neuropsychiatric damage (OR=3.0, 95%CI 1.2-7.6, p=0.015). A ROC analysis identified that a cut-off >24 in 2019-EULAR/ACR score could predict a trend for renal damage (p=0.077) with a lower renal survival (Kaplan-Meier curve) for patients above this limit (p=0.029). A multivariate logistic regression analysis revealed that 2019-EULAR/ACR score >24 at diagnosis (OR 4.583, 95%CI 1.052-19.962, p=0.043) was independently associated with renal damage. Specific domains in the 2019-EULAR/ACR criteria at diagnosis were associated with long-term organ-specific damage, particularly renal and neuropsychiatric harm. A 2019-EULAR/ACR score >24 predicted worse renal survival. Key Points • Presence of renal domain of the 2019-EULAR/ACR classification criteria at diagnosis was associated with long-term renal damage. • Presence of antiphospholipid antibodies domain at diagnosis was associated with long-term neuropsychiatric damage. • A 2019-EULAR/ACR overall score >24 at diagnosis was independently associated with renal damage and predicted worse renal long-term survival.
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Affiliation(s)
- Carlos E Insfrán
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
| | - Nadia E Aikawa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
| | - Dilson M N Filho
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
| | - Francisco F C Formiga
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
| | - Ana C Pitta
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo F Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
| | - Carolina T Ribeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
| | - Clovis A Silva
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, no 455, sala 3190 - Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil.
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Medeiros-Ribeiro AC, Aikawa NE, Saad CGS, Yuki EFN, Pedrosa T, Fusco SRG, Rojo PT, Pereira RMR, Shinjo SK, Andrade DCO, Sampaio-Barros PD, Ribeiro CT, Deveza GBH, Martins VAO, Silva CA, Lopes MH, Duarte AJS, Antonangelo L, Sabino EC, Kallas EG, Pasoto SG, Bonfa E. Immunogenicity and safety of the CoronaVac inactivated vaccine in patients with autoimmune rheumatic diseases: a phase 4 trial. Nat Med 2021; 27:1744-1751. [PMID: 34331051 DOI: 10.1038/s41591-021-01469-5] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/15/2021] [Indexed: 02/08/2023]
Abstract
CoronaVac, an inactivated SARS-CoV-2 vaccine, has been approved for emergency use in several countries. However, its immunogenicity in immunocompromised individuals has not been well established. We initiated a prospective phase 4 controlled trial (no. NCT04754698, CoronavRheum) in 910 adults with autoimmune rheumatic diseases (ARD) and 182 age- and sex-frequency-matched healthy adults (control group, CG), who received two doses of CoronaVac. The primary outcomes were reduction of ≥15% in both anti-SARS-CoV-2 IgG seroconversion (SC) and neutralizing antibody (NAb) positivity 6 weeks (day 69 (D69)) after the second dose in the ARD group compared with that in the CG. Secondary outcomes were IgG SC and NAb positivity at D28, IgG titers and neutralizing activity at D28 and D69 and vaccine safety. Prespecified endpoints were met, with lower anti-SARS-Cov-2 IgG SC (70.4 versus 95.5%, P < 0.001) and NAb positivity (56.3 versus 79.3%, P < 0.001) at D69 in the ARD group than in the CG. Moreover, IgG titers (12.1 versus 29.7, P < 0.001) and median neutralization activity (58.7 versus 64.5%, P = 0.013) were also lower at D69 in patients with ARD. At D28, patients with ARD presented with lower IgG frequency (18.7 versus 34.6%, P < 0.001) and NAb positivity (20.6 versus 36.3%, P < 0.001) than that of the CG. There were no moderate/severe adverse events. These data support the use of CoronaVac in patients with ARD, suggesting reduced but acceptable short-term immunogenicity. The trial is still ongoing to evaluate the long-term effectiveness/immunogenicity.
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Affiliation(s)
- Ana C Medeiros-Ribeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nadia E Aikawa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carla G S Saad
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Emily F N Yuki
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tatiana Pedrosa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Solange R G Fusco
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Priscila T Rojo
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosa M R Pereira
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Samuel K Shinjo
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Danieli C O Andrade
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Percival D Sampaio-Barros
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carolina T Ribeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Giordano B H Deveza
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Victor A O Martins
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marta H Lopes
- Infectious Disease Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alberto J S Duarte
- Central Laboratory Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Leila Antonangelo
- Central Laboratory Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ester C Sabino
- Infectious Disease Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Esper G Kallas
- Infectious Disease Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
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Yuki EFN, Silva CA, Aikawa NE, Romiti R, Heise CO, Bonfa E, Pasoto SG. Thalidomide and Lenalidomide for Refractory Systemic/Cutaneous Lupus Erythematosus Treatment: A Narrative Review of Literature for Clinical Practice. J Clin Rheumatol 2021; 27:248-259. [PMID: 31693649 DOI: 10.1097/rhu.0000000000001160] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Thalidomide has shown exceptional results in systemic/cutaneous lupus erythematosus(SLE/CLE). Recently, lenalidomide has been also prescribed for SLE/CLE treatment. Literature regarding efficacy/adverse events for these drugs is scarce with a single systematic review and meta-analysis focused solely on thalidomide for refractory cutaneous lupus subtypes. OBJECTIVE We, therefore, addressed in this narrative review the efficacy/adverse effects of thalidomide and lenalidomide for SLE and CLE. In addition, we provide a specialist approach for clinical practice based on the available evidence. RESULTS Efficacy of thalidomide for refractory cutaneous lupus treatment was demonstrated by several studies, mostly retrospective with small sample size(≤20). The frequency of peripheral polyneuropathy is controversial varying from 15-80% with no consistent data regarding cumulative dose and length of use. Drug withdrawn results in clinical partial/complete reversibility for most cases (70%). For lenalidomide, seven studies (small sample sizes) reported its efficacy for SLE/CLE with complete/partial response in all patients with a mean time to response of 3 months. Flare rate varied from 25-75% occurring 0.5-10 months after drug withdrawn. There were no reports of polyneuropathy/worsening of previous thalidomide-induced neuropathy, but most of them did not perform nerve conduction studies. Teratogenicity risk exist for both drugs and strict precautions are required. CONCLUSIONS Thalidomide is very efficacious as an induction therapy for patients with severe/refractory cutaneous lupus with high risk of scarring, but its longstanding use should be avoided due to neurotoxicity. Lenalidomide is a promising drug for skin lupus treatment, particularly regarding the apparent lower frequency of nerve side effects.
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Affiliation(s)
| | | | | | | | - Carlos Otto Heise
- Neurology Department, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil
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Fargetti S, Ugolini-Lopes MR, Pasoto SG, Seguro LPC, Shinjo SK, Bonfa E, Borba EF. Short- and Long-Term Outcome of Systemic Lupus Erythematosus Peripheral Neuropathy: Bimodal Pattern of Onset and Treatment Response. J Clin Rheumatol 2021; 27:S212-S216. [PMID: 31651643 DOI: 10.1097/rhu.0000000000001201] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Our aim was to describe the short- and long-term outcome of peripheral neuropathy (PN) attributed exclusively to systemic lupus erythematosus (SLE). METHODS Systemic lupus erythematosus patients with defined PN (clinical and electroneuromyography) were retrospectively evaluated at onset, 1-year, and 5-year follow-up using a standardized electronic chart database that started in 2000. Exclusion criteria were comorbidities, drugs, and infections. Age-, sex-, and disease duration-matched SLE patients without PN were selected as controls. RESULTS Lupus PN was identified in 38 (1.8%) of 2074 patients, and almost two thirds had PN onset in the first 5 years of SLE (63.2%). Peripheral neuropathy SLE had higher frequencies of cutaneous vasculitis (50% vs 21.1%, p = 0.002), lymphopenia (60.5% vs 36.8%, p = 0.027), anti-Sm (52.6% vs 27.6%, p = 0.013), and higher SLEDAI-2K scores (11.5 ± 10.5 vs 4.9 ± 6.7, p < 0.001) compared with controls. The most common type was polyneuropathy (71.1%) with sensory-motor pattern (68.4%). At PN diagnosis, all patients received glucocorticoid and 97.4% started immunosuppressive therapy (50% intravenous cyclophosphamide, 42.1% azathioprine). After 1-year follow-up, 92.1% had a favorable outcome with complete (36.8%) or partial remission (55.2%), in parallel with a decrease in prednisone dose (48.3 ± 17.9 vs 15.3 ± 13.4 mg/d, p < 0.001), symptomatic therapy (57.9% vs 29.7%, p = 0.02), and SLEDAI-2K score (11.5 ± 10.5 vs 1.7 ± 3.7, p < 0.001). SLEDAI-2K scores were higher in patients who had PN onset with less than 1 year of SLE duration, compared with those with more than 5 years of disease (21.3 ± 9.1 vs 3.9 ± 5.3, p < 0.001). Early-PN-onset group had a better response to treatment (complete remission at 1-year follow-up 61.5% vs 25%, p = 0.039). At 5-year follow-up, 89.3% remained with complete/partial remission. CONCLUSIONS Peripheral neuropathy attributed to SLE itself is a rare manifestation with a bimodal pattern, characterized by a predominant early-onset group associated with high disease activity and a higher rate of complete remission, and a late-onset group with low disease activity and a partial therapy response.
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Affiliation(s)
- Simone Fargetti
- From the Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Reátegui-Sokolova C, Ugarte-Gil MF, Harvey GB, Wojdyla D, Pons-Estel GJ, Quintana R, Serrano-Morales RM, Sacnun MP, Catoggio LJ, Soriano ER, García MA, Saurit V, Alvarellos A, Caeiro F, Berbotto GA, Sato EI, Borba Neto EF, Bonfa E, de Oliveira E Silva Montandon AC, Da Silva NA, Cavalcanti F, Vásquez G, Guibert-Toledano M, Reyes-Llerena GA, Massardo L, Neira OJ, Cardiel MH, Barile-Fabris LA, Amigo MC, Silveira LH, Portela-Hernández M, Garcia de la Torre I, Segami MI, Chacón-Diaz R, Esteva-Spinetti MH, Alarcón GS, Pons-Estel BA. Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL). RMD Open 2021; 6:rmdopen-2020-001299. [PMID: 33310863 PMCID: PMC7859505 DOI: 10.1136/rmdopen-2020-001299] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/16/2020] [Accepted: 10/21/2020] [Indexed: 11/24/2022] Open
Abstract
Aim A decrease in proteinuria has been considered protective from renal damage in lupus nephritis (LN), but a cut-off point has yet to be established. The aim of this study was to identify the predictors of renal damage in patients with LN and to determine the best cut-off point for a decrease in proteinuria. Methods We included patients with LN defined clinically or histologically. Possible predictors of renal damage at the time of LN diagnosis were examined: proteinuria, low complement, anti-double-stranded DNA antibodies, red cell casts, creatinine level, hypertension, renal activity (assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)), prednisone dose, immunosuppressive drugs and antimalarial use. Sociodemographic variables were included at baseline. Proteinuria was assessed at baseline and at 12 months, to determine if early response (proteinuria <0.8 g/day within 12 months since LN diagnosis) is protective of renal damage occurrence. Renal damage was defined as an increase of one or more points in the renal domain of The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). Cox regression models using a backward selection method were performed. Results Five hundred and two patients with systemic lupus erythematosus patients were included; 120 patients (23.9%) accrued renal damage during their follow-up. Early response to treatment (HR=0.58), antimalarial use (HR=0.54) and a high SES (HR=0.25) were protective of renal damage occurrence, whereas male gender (HR=1.83), hypertension (HR=1.86) and the renal component of the SLEDAI (HR=2.02) were risk factors for its occurrence. Conclusions Early response, antimalarial use and high SES were protective of renal damage, while male gender, hypertension and higher renal activity were risk factors for its occurrence in patients with LN.
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Affiliation(s)
- Cristina Reátegui-Sokolova
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú .,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
| | - Manuel F Ugarte-Gil
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,Universidad Científica del Sur, Lima, Perú
| | - Guillermina B Harvey
- Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | | | | | - Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | | | | | | | - Mercedes A García
- Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
| | - Verónica Saurit
- Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | | | | | | | - Emilia I Sato
- Universidade Federal da Sao Paulo (UNIFESP), Sao Paulo, Brasil
| | | | - Eloisa Bonfa
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
| | | | - Nilzio A Da Silva
- Faculdade de Medicina, Universidade Federal de Goias, Goiânia, Brasil
| | - Fernando Cavalcanti
- Servico de Reumatologia, Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE), Recife, Brasil
| | - Gloria Vásquez
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Loreto Massardo
- Facultad de Medicina, Universidad San Sebastián, Santiago, Chile
| | - Oscar J Neira
- Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Mario H Cardiel
- Centro de Investigación Clínica de Morelia SC, Morelia, Mexico
| | | | | | - Luis H Silveira
- Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Margarita Portela-Hernández
- Departamento de Reumatología, Hospital de Especialidades CMN SXXI, Instituto Mexicano de Seguridad Social, Ciudad de México, Mexico
| | | | | | - Rosa Chacón-Diaz
- Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela
| | | | - Graciela S Alarcón
- The University of Alabama at Birmingham, Birmingham, Alabama, Alabama, USA.,Universidad Peruana Cayetano Heredia, Lima, Perú
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Abdo RCT, Gobbi RG, Leite CBG, Pasoto SG, Leon EP, Lima ALLM, Bonfa E, Pécora JR, Demange MK. Performance of alpha-defensin lateral flow test after synovial fluid centrifugation for diagnosis of periprosthetic knee infection. World J Orthop 2021; 12:565-574. [PMID: 34485103 PMCID: PMC8384616 DOI: 10.5312/wjo.v12.i8.565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The quantitative alpha-defensin enzyme-linked immunosorbent assay (ELISA) demands a prior synovial fluid centrifugation, whereas this processing is not routinely required prior to the alpha-defensin lateral flow test.
AIM To evaluate whether a prior synovial fluid centrifugation could lead the lateral flow performance to achieve comparable results to ELISA during periprosthetic joint infection (PJI) diagnosis.
METHODS Fifty-three cases were included in this study: 22 classified as PJI and 31 classified as aseptic cases, according to Musculoskeletal Infection Society 2013 criteria. Synovial fluid samples were submitted to centrifugation, and the supernatant was evaluated by ELISA and lateral flow tests. The sensitivity (SE), specificity (SP) and accuracy of each method were calculated as well as the agreement between those two methods.
RESULTS In all of the 31 samples from aseptic patients, alpha-defensin ELISA and lateral flow tests showed negative results for infection. Regarding the 22 infected patients, the lateral flow test was positive in 19 cases (86.4%) and the ELISA was positive in 21 (95.5%). Sensibility, SP and accuracy were, respectively, 86.4% (95%CI: 65.1%-97.1%), 100% (95%CI: 88.8%-100%) and 93.2% (95%CI: 82.8%-98.3%) for the lateral flow test and 95.5% (95%CI: 77.2%-99.9%), 100% (95%CI: 88.8%-100%) and 98.1% (95%CI: 89.9%-100%) for ELISA. An agreement of 96.2% between those methods were observed. No statistical difference was found between them (P = 0.48).
CONCLUSION Alpha-defensin lateral flow test showed high SE, SP and accuracy after a prior synovial fluid centrifugation, achieving comparable results to ELISA. Considering the lower complexity of the lateral flow and its equivalent performance obtained in this condition, a prior centrifugation might be added as a valuable step to enhance the PJI diagnosis.
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Affiliation(s)
- Rodrigo Calil Teles Abdo
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
| | - Riccardo Gomes Gobbi
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
| | - Chilan Bou Ghosson Leite
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
| | - Sandra Gofinet Pasoto
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 01246-903, Brazil
| | - Elaine Pires Leon
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 01246-903, Brazil
| | - Ana Lucia Lei Munhoz Lima
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
| | - Eloisa Bonfa
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 01246-903, Brazil
| | - José Ricardo Pécora
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
| | - Marco Kawamura Demange
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil
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Abstract
Childhood-onset systemic lupus erythematosus (cSLE) is a prototype of a multisystemic, inflammatory, heterogeneous autoimmune condition. This disease is characterized by simultaneous or sequential organ and system involvement, with unpredictable flare and high levels of morbidity and mortality. Racial/ethnic background, socioeconomic status, cost of medications, difficulty accessing health care, and poor adherence seem to impact lupus outcomes and treatment response. In this article, the management of cSLE patients is updated. Regarding pathogenesis, a number of potential targets for drugs have been studied. However, most treatments in pediatric patients are off-label drugs with recommendations based on inadequately powered studies, therapeutic consensus guidelines, or case series. Management practices for cSLE patients include evaluations of disease activity and cumulative damage scores, routine non-live vaccinations, physical activity, and addressing mental health issues. Antimalarials and glucocorticoids are still the most common drugs used to treat cSLE, and hydroxychloroquine is recommended for nearly all cSLE patients. Disease-modifying antirheumatic drugs (DMARDs) should be standardized for each patient, based on disease flare and cSLE severity. Mycophenolate mofetil or intravenous cyclophosphamide is suggested as induction therapy for lupus nephritis classes III and IV. Calcineurin inhibitors (cyclosporine, tacrolimus, voclosporin) appear to be another good option for cSLE patients with lupus nephritis. Regarding B-cell-targeting biologic agents, rituximab may be used for refractory lupus nephritis patients in combination with another DMARD, and belimumab was recently approved by the US Food and Drug Administration for cSLE treatment in children aged > 5 years. New therapies targeting CD20, such as atacicept and telitacicept, seem to be promising drugs for SLE patients. Anti-interferon therapies (sifalimumab and anifrolumab) have shown beneficial results in phase II randomized control trials in adult SLE patients, as have some Janus kinase inhibitors, and these could be alternative treatments for pediatric patients with severe interferon-mediated inflammatory disease in the future. In addition, strict control of proteinuria and blood pressure is required in cSLE, especially with angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use.
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Affiliation(s)
- Vitor Cavalcanti Trindade
- Children and Adolescent Institute, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Magda Carneiro-Sampaio
- Children and Adolescent Institute, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Clovis Artur Silva
- Children and Adolescent Institute, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
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Barile-Fabris LA, Fragoso-Loyo H, Wojdyla D, Quintana R, Pons-Estel GJ, Catoggio LJ, García MA, Saurit V, Drenkard C, Bonfa E, Borba EF, Sato E, Tavares Brenol JC, Cavalcanti F, Da Silva NA, Lavras Costallat LT, Guibert Toledano M, Massardo L, Neira O, Cardiel MH, Amigo MC, García De La Torre I, Silveira LH, Acevedo Vásquez EM, Chacón-Diaz R, Esteva-Spinetti MH, Alarcón GS, Pons-Estel BA. Factors associated with neuropsychiatric involvement in Latin American patients with systemic lupus erythematosus. Lupus 2021; 30:1481-1491. [PMID: 34082589 DOI: 10.1177/09612033211020364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Factors related to presentation of neuropsychiatric (NP) SLE manifestations, early in the course of the disease, and during follow up have not been clearly established. PURPOSE To identify disease and non-disease related factors associated with NP manifestations in early SLE. METHODS We included 1193 patients from the GLADEL inception cohort free of NP involvement at cohort entry. We evaluated the association of demographic, clinical and laboratory data with NP involvement during follow-up. STATISTICAL METHODS Independent factors associated with NP involvement were identified using a multivariable Cox regression model. RESULTS Factors independently associated with NP manifestations were: mestizo ethnicity (HR 1.701, 95% CI 1.282-2.258, p = 0.0002), myalgias/myositis (HR 1.832, 95% CI 1.335-2.515, p = 0.0002), pneumonitis (HR 2.476, 95% CI 1.085-5.648, p = 0.0312), shrinking lung (HR 2.428, 95% CI 1.074-5.493, p = 0.0331) and hemolytic anemia (HR 1.629, 95% CI 1.130-2.347, p = 0.0089). Longer disease duration at cohort entry (13 to 24 months) was associated with a lower risk of developing NP manifestations (HR 0.642, 95% CI 0.441-0.934, p = 0.0206). CONCLUSIONS Patients with myalgias/myositis, pneumonitis, shrinking lung and hemolytic anemia are at higher risk of NP involvement, whereas longer disease duration at cohort entry is associated with a lower risk of developing NP involvement.
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Affiliation(s)
| | - Hilda Fragoso-Loyo
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Ciudad de México, México
| | | | - Rosana Quintana
- Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Guillermo J Pons-Estel
- Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Luis J Catoggio
- Sección de Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Instituto Universitario Escuela de Medicina y Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - Mercedes A García
- Servicio de Reumatología, HIGA General San Martín, La Plata, Argentina
| | - Verónica Saurit
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Cristina Drenkard
- Division of Rheumatology, Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo SP, Brasil
| | - Eduardo F Borba
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo SP, Brasil
| | - Emilia Sato
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paul, Brasil
| | - Joao C Tavares Brenol
- Rheumatology Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Fernando Cavalcanti
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE), Recife, Brasil
| | - Nilzio A Da Silva
- Serviço de Reumatologia, Departamento de Clinica Medica, Facultad de Medicina, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brasil
| | - Lilian T Lavras Costallat
- Departamento de Clínica Médica, Faculdade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brasil
| | - Marlene Guibert Toledano
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico-Quirúrgicas (CIMEQ), La Habana, Cuba
| | - Loreto Massardo
- Facultad de Medicina y Ciencia, Centro de Biología Celular y Biomedicina, Universidad San Sebastián, Santiago, Chile
| | - Oscar Neira
- Sección de Reumatología, Hospital del Salvador, Universidad de Chile, Unidad de Reumatología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Mario H Cardiel
- Centro de Investigación Clínica de Morelia, SC, Morelia, México
| | - Mary Carmen Amigo
- Servicio de Reumatología, Centro Médico ABC, Ciudad de México, México
| | | | - Luis H Silveira
- Departamento de Reumatología, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México
| | - Eduardo M Acevedo Vásquez
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Servicio de Reumatología. Clínica San Felipe, Jesús María, Lima, Perú
| | - Rosa Chacón-Diaz
- Servicio de Reumatología, Policlínica Méndez Gimón, Caracas, Venezuela
| | | | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano, Heredia, Lima, Perú
| | - Bernardo A Pons-Estel
- Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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Salviato Pileggi G, Ferreira G, Gomides AP, Reis Neto E, Abreu M, Albuquerque C, Araújo N, Bacchiega AB, Bianchi D, Bica B, Bonfa E, Borba E, Brito D, Duarte A, Peixoto Gu e Silva de Souza M, Wagner Poti Gomes K, Maria Kakehasi A, Cavalheiro Do Espírito Santo R, Realle P, Klumb E, Lanna CC, Marques C, Monticielo O, Mota L, Munhoz G, Paiva E, Pereira H, Provenza JR, Ribeiro S, Rocha Jr L, Sampaio C, Sampaio V, Sato E, Laroca Skare T, De Souza V, Valim V, Lacerda M, Xavier R, Pinheiro M. POS1252 COVID-19 IN PATIENTS WITH RHEUMATIC DISEASES ON CHRONIC USE OF HYDROXYCHLOROQUINE IN A LARGE BRAZILIAN COHORT – A 24-WEEK PROSPECTIVE STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The role of chronic use of hydroxychloroquine (HCQ) in rheumatic disease (RD) patients during the SARS-CoV-2 pandemic is still subject of discussion.Objectives:To compare the occurrence of COVID-19 and its outcomes between RD patients on HCQ use with individuals from the same household not taking the drug during community viral transmission in an observational prospective multicenter study in Brazil.Methods:Participants were enrolled and monitored through 24-week (From March 29th to Sep 30th, 2020) regularly scheduled phone calls performed by trained medical professionals. Epidemiological and demographic data, as well as RD disease activity status and current treatment data, specific information about COVID-19, hospitalization, need for intensive care, and death was recorded in both groups and stored in the Research Electronic Data Capture (REDCap) database. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. The statistical analysis was performed using IBM-SPSS v.20.0 software. Group comparisons were made using the Man-Whitney, Chi-Square and Fisher Exact Test, as well as multivariate regression models adjusted to confounders. Survival curves were performed using Kaplan-Meier analysis.Results:A total of 10,427 participants mean age (SD) of 44.04 (14.98) years were enrolled, including 6004 (57.6%) rheumatic disease patients, of whom 70.8% had systemic lupus erythematosus (SLE), 6.7% rheumatoid arthritis (RA), 4% primary Sjögren’s syndrome (pSS), 1.8% mixed connective tissue disease (DMTC), 1% systemic sclerosis (SSc) and others (15.9), including overlap syndromes. In total, 1,132 (10.8%) participants fulfilled criteria for COVID-19, being 6.7% RD patients and 4.1% controls (p=0.002). A recent influenza vaccination had a protective role (p<0.001). Moderate and severe COVID-19 included the need for hospitalization, intensive care, mechanical ventilation or death. Infection severity was not different between groups (p=0.391) (Table 1). After adjustments for multiple confounders, the main risk factors significantly associated with COVID-19 were higher education level (OR=1.29 95%CI 1.05-1.59), being healthcare professionals (OR=1.91; 95%CI 1.45-2.53), presence of two comorbidities (OR=1.31; 95%CI 1.01-1.66) and three or more comorbidities associated (OR=1.69; 95%CI 1.23-2.32). Interestingly, age >=65 years (OR=0.20; 95%CI 0.11-0.34) was negatively associated. Regarding RD, the risk factors associated with COVID-19 diagnosys were SLE (OR= 2.37; 95%CI 1.92-293), SSc (OR=2.25; 95%CI 1.05-4.83) and rituximab use (OR=1.92; 95%CI 1.13-3.26). In addition, age >=65 years (OR=5.47; 95%CI 1.7-19.4) and heart disease (OR=2.60; 95%CI 1.06-6.38) were associated with hospitalization. Seven female RD patients died, six with SLE and one with pSS, and the presence of two or more comorbidities were associated with higher mortality rate.Conclusion:Chronic HCQ use did not prevent COVID-19 in RD compared to their household cohabitants. Health care profession, presence of comorbidities LES, SSc and rituximab were identified as main risk factors for COVID-19 and aging and heart disease as higher risk for hospitalization. Our data suggest these outcomes could be considered to manage them in clinical practice.Table 1.Frequency and severity of COVID-19 in patients with rheumatic diseases on chronic use of hydroxychloroquine compared to their household controlsCOVID-19 outcomesTotal(%)GroupsPPatients(%)Controls (%)DiagnosisNo9256 (89.1)5300 (88.3)3956 (90.2)0.002Yes1132 (10.9)704 (11.7)428 (9.8)SeverityMild1059 (93.6)662 (94.0)397 (92.8)0.391Moderate52 (4.6)32 (4.5)20 (4.7)Severe21 (1.9)10 (1.4)11 (2.6)HCQ: hydroxychloroquine.Moderate and severe COVID-19 included the need for any of the following: hospitalization, intensive care, mechanical ventilation or death.Acknowledgements:To the Brazilian Society of Rheumatology for technical support and rapid nationwide mobilization.To all the 395 interviewers (medical students and physicians) who collaborated in the study and the participantsTo CNPq (Number 403442/2020-6)Disclosure of Interests:None declared
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Pinheiro MM, Pileggi GS, Kakehasi AM, Gomides Reis APM, Reis-Neto ET, Abreu MM, Albuquerque CP, Araújo NC, Bacchiega AB, Bianchi DV, Bica B, Bonfa E, Borba EF, Egypto Brito DC, Calderaro DC, Pinto Duarte ÂL, Espírito Santo RC, Fernandes PR, Guimarães MP, Poti Gomes KW, Faustino Ilana GG, Klumb EM, Marques CD, Guedes de Melo AK, Monticielo OA, Mota LM, Munhoz GA, Paiva ES, Pereira HLA, Provenza JR, Ribeiro SLE, Rocha Jr LF, Sato EI, Skare T, de Souza VA, Valim V, Lacerda MV, Xavier RM, Ferreira GA. Incidence and risk factors for moderate/severe COVID-19 in rheumatic diseases patients on hydroxychloroquine: a 24-week prospective cohort. Clin Exp Rheumatol 2021; 40:1258-1266. [DOI: 10.55563/clinexprheumatol/67oyux] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Marcelo M. Pinheiro
- Hospital São Paulo da Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp/EPM), São Paulo-SP, Brazil.
| | - Gecilmara S. Pileggi
- Hospital São Paulo da Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp/EPM), São Paulo-SP, Brazil
| | - Adriana M. Kakehasi
- Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte-MG, Brazil
| | - Ana Paula M. Gomides Reis
- Hospital Universitário de Brasília da Universidade de Brasília, EBSERH (HUB-UnB), Brasília-DF, Brazil
| | - Edgard Torres Reis-Neto
- Hospital São Paulo da Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp/EPM), São Paulo-SP, Brazil
| | - Mirhelen M. Abreu
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
| | - Cleandro P. Albuquerque
- Hospital Universitário de Brasília da Universidade de Brasília, EBSERH (HUB-UnB), Brasília-DF, Brazil
| | - Nafice C. Araújo
- Hospital do Servidor Público Estadual, Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo-SP, Brazil
| | - Ana Beatriz Bacchiega
- Faculdade de Medicina de Barretos (FACISB), Education & Research Institute Cancer Hospital Barretos, Barretos-SP, Brazil
| | - Dante V. Bianchi
- Santa Casa de Misericórdia do Rio de Janeiro (HGSCMRJ), Rio de Janeiro-RJ, Brazil
| | - Blanca Bica
- Hospital São Paulo da Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp/EPM), São Paulo-SP, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo-SP, Brazil
| | - Eduardo F. Borba
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo-SP, Brazil
| | | | - Debora C. Calderaro
- Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte-MG, Brazil
| | | | - Rafaela C. Espírito Santo
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil
| | - Paula R. Fernandes
- Hospital Universitário da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil
| | | | | | - Gabriela G. Faustino Ilana
- Centro Avançado de Pesquisa, Estudos e Diagnóstico (CAPED), Centro Médico Ribeirão shopping, Ribeirão Preto-SP, Brazil
| | - Evandro M. Klumb
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro-RJ, Brazil
| | - Claudia D.L. Marques
- Hospital das Clínicas da Universidade Federal de Pernambuco (UFPE), Recife-PE, Brazil
| | - Ana Karla Guedes de Melo
- Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba (UFPB), João Pessoa-PB, Brazil
| | - Odirlei A. Monticielo
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil
| | - Licia M.H. Mota
- Hospital Universitário de Brasília da Universidade de Brasília, EBSERH (HUB-UnB), Brasília-DF, Brazil
| | - Gabriela A. Munhoz
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo-SP, Brazil
| | | | | | | | | | - Laurindo F. Rocha Jr
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP/PE), Recife-PE, Brazil
| | - Emilia I. Sato
- Hospital São Paulo da Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp/EPM), São Paulo-SP, Brazil
| | - Telma Skare
- Hospital Universitário Evangélico Mackenzie (HUEM), Curitiba-PR, Brazil
| | - Viviane A. de Souza
- Hospital Universitário da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil
| | - Valeria Valim
- Hospital Universitário Cassiano Antonio de Moraes, Universidade Federal do Espírito Santo, Vitória-ES, Brazil
| | | | - Ricardo M. Xavier
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil
| | - Gilda A. Ferreira
- Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte-MG, Brazil
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Pons-Estel GJ, Ugarte-Gil MF, Harvey GB, Wojdyla D, Quintana R, Saurit V, Soriano ER, Bonfa E, Massardo L, Cardiel M, Vila LM, Griffin R, Pons-Estel BA, Alarcón GS. Applying the 2019 EULAR/ACR lupus criteria to patients from an established cohort: a Latin American perspective. RMD Open 2021; 6:rmdopen-2019-001097. [PMID: 31958284 PMCID: PMC6999682 DOI: 10.1136/rmdopen-2019-001097] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/20/2019] [Accepted: 12/15/2019] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the performance of the 2019 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) criteria in terms of earlier patients’ classification in comparison to the 1982/1997 ACR or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria. Materials and methods Patients from a Latin America, multiethnic, multicentre cohort, where SLE was defined using the physicians’ diagnosis, were included. To calculate the sensitivity of the 2019 EULAR/ACR criteria, the 1982/1997 ACR criteria were considered the gold standard. Additionally, comparison of the 1982/1997 ACR criteria and the 2012 SLICC criteria with the 2019 EULAR/ACR criteria was performed. Results The sensitivity of the 2019 EULAR/ACR criteria when compared with the 1982/1997 ACR criteria as the gold standard was 91.3%. This new set of criteria allowed an earlier SLE patient classification in 7.4% (mean 0.67 years) and 0.6% (mean 1.47 years) than the 1982/1997 ACR and the 2012 SLICC criteria, respectively. Patients accruing the 2019 EULAR/ACR earlier than the 1982/1997 ACR criteria were more likely to have high anti-dsDNA titres; those accruing them later were less likely to have mucocutaneous and joint manifestations; this was not observed when comparing them with the 2012 SLICC criteria. Conclusions The 2019 EULAR/ACR criteria classified earlier only a small proportion of Latin America patients than with the two other criteria sets in real-life clinical practice scenarios. Further studies in different patient populations are needed before these new criteria are adopted worldwide.
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Affiliation(s)
- Guillermo J Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina .,Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
| | - Manuel Francisco Ugarte-Gil
- School of Medicine, Universidad Cientifica del Sur, Lima, Peru.,Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen. EsSalud, Lima, Peru
| | - Guillermina B Harvey
- Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | - Daniel Wojdyla
- Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | - Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina.,Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
| | - Verónica Saurit
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Córdoba, Argentina
| | - Enrique R Soriano
- Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Eloisa Bonfa
- Rheumatology, Faculdade de Medicina da Universidade de São Paulo-USP, São Paulo, SP, Brazil
| | - Loreto Massardo
- Centro de Biología Celular y Biomedicina, Universidad San Sebastián, Santiago, Chile
| | - Mario Cardiel
- Centro de Investigacion Clinica de Morelia, Morelia, Michoacán, Mexico
| | - Luis M Vila
- Division of Rheumatology, University of Puerto Rico, San Juan, San Juan, Puerto Rico
| | - Russell Griffin
- Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina
| | - Graciela S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama, Birmingham, Alabama, USA
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Lourenço DMR, Araújo DB, Aikawa NE, Yamakami LYS, Borba EF, Maciel GAR, Soares-Junior JM, Baracat EC, Pereira RMR, Bonfa E, Silva CA. Adrenal steroidogenesis and ovarian reserve in adult childhood-onset systemic lupus erytematosus patients. Clin Rheumatol 2021; 40:3651-3658. [PMID: 33712890 DOI: 10.1007/s10067-021-05677-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess overall adrenal mineralocorticoid/glucocorticoid/androgen steroidogenesis in childhood-onset systemic lupus erythematosus (cSLE) patients and the possible effect of prednisone on adrenal hormones and ovarian reserve. METHODS Fifty-one adult cSLE (ACR criteria) patients and 23 healthy controls were evaluated for adrenal steroidogenesis including mineralocorticoid (progesterone, deoxycorticosterone, aldosterone), glucocorticoid (17-OHprogesterone, 11-desoxycortisol, cortisol), and androgen (dehydroepiandrosterone-sulfate, androstenedione, total testosterone, and dihydrotestosterone) hormones. Ovarian reserve assessment included follicle-stimulating hormone (FSH), estradiol, anti-Müllerian hormone, ovarian volumes, and antral follicle count. RESULTS The median of current age [29.11 (19-39.8) vs. 30.8 (19.6-42.1) years, p = 0.502] was similar in adult cSLE and controls. Regarding mineralocorticoid/glucocorticoid, the median of progesterone (p = 0.003), 17-OH progesterone (p < 0.001), and 11-desoxycortisol (p = 0.036) were significantly lower in patients compared to controls. All androgen steroidogenesis hormones were reduced in the former group [dehydroepiandrosterone-sulfate (p < 0.001), androstenedione (p = 0.001), total testosterone (p = 0.005), and dihydrotestosterone (p < 0.001)]. Further comparison of patients with and without current use of prednisone and controls revealed a predominant impact on adrenal glucocorticoid and androgen steroidogenesis with reduced levels of 17-OH progesterone [0.17 (0-0.5) vs. 0.27 (0.1-2.9) vs. 0.33 (0.1-0.8) ng/mL, p < 0.001], dehydroepiandrosterone-sulfate [0.155 (0-0.6) vs. 0.49 (0.1-1.6) vs. 1.11 (0.1-2.6) μg/mL, p < 0.001], androstenedione [0.56 (0.2-4.4) vs. 1.7 (0.5-4.5) vs. 2.33 (0.3-3.8) ng/mL, p < 0.001], total testosterone [12 (12-167) vs. 16 (12-28) vs. (16.5 (0-50) ng/d, p = 0.002], and dihydrotestosterone [92.68 (11.8-198.5) vs. 160.62 (37.9-842.1) vs. 188.3 (71.3-543.9) pg/ml, p < 0.001] in patients under this drug. In addition, patients with this therapy had reduced median ovarian volumes [4.14 (2-12) vs. 7.13 (2-25.7) vs. 5.18 (2.4-17.3) cm3, p = 0.028) that was not associated with cyclophosphamide cumulative dose (p > 0.05). The median prednisone dose was 15/mg/day (2.5-40). CONCLUSIONS We provided novel evidence that cSLE patients have an overall androgen/glucocorticoid/mineralocorticoid adrenal suppression. Furthermore, low/moderate prednisone use seems to underlie these abnormalities and may also adversely affect ovarian reserve, independently of immunosuppressants. Key Points • cSLE patients have an overall androgen/glucocorticoid/mineralocorticoid adrenal suppression. • Low/moderate prednisone use may affect ovarian reserve, independently of immunosuppressants.
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Affiliation(s)
- Daniela M R Lourenço
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Daniel B Araújo
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil.,Internal Medicine Department, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Nadia E Aikawa
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil.,Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Lucas Y S Yamakami
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo F Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Gustavo A R Maciel
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Jose M Soares-Junior
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Edmund C Baracat
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rosa M R Pereira
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho Aguiar, 647 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. .,Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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Yuki EFN, Soares R, Kupa LDVK, Heise CO, Aikawa NE, Arnone M, Romiti R, Pedrosa TDN, Silva CAAD, Bonfa E, Pasoto SG. One-year prospective nerve conduction study of thalidomide neuropathy in lupus erythematosus: Incidence, coasting effect and drug plasma levels. Lupus 2021; 30:956-964. [PMID: 33657919 DOI: 10.1177/0961203321998433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Few prospective studies in cutaneous and systemic lupus erythematosus (CLE/SLE) assessed thalidomide-induced peripheral neuropathy (TiPN) incidence/reversibility, and most have not excluded confounding causes neither monitored thalidomide plasma levels. OBJECTIVES To evaluate TiPN incidence/reversibility, coasting effect and its association with thalidomide plasma levels in CLE/SLE. METHODS One-year prospective study of thalidomide in 20 CLE/SLE patients without pregnancy potential, with normal nerve conduction study (NCS), and excluded other PN causes. Thalidomide levels were determined by high-performance liquid chromatography/tandem mass spectrometry. RESULTS Twelve patients (60%) developed TiPN: 33.3% were symptomatic and 66.6% asymptomatic. Half of this latter group developed coasting effect (TiPN symptoms 1-3 months after drug withdrawal). The main predictive factors for TiPN were treatment duration ≥6 months (p = 0.025) and cumulative dose (p = 0.023). No difference in plasma thalidomide levels between patients with/without TiPN was observed (p = 0.464). After drug withdrawal, 75% symptomatic TiPN patients improved their symptoms. Seven TiPN patients underwent an additional NCS after drug withdrawal: 42.8% worsened NCS, 14.2% was stable, and 42.8% had improved NCS. CONCLUSION Our data provides novel evidence of coasting effect in half of asymptomatic patients with TiPN. The irreversible nature of this lesion in 25% of TiPN patients reinforces the relevance of early NCS monitoring, and suggests thalidomide use solely as a bridge for other effective therapy for refractory cutaneous lupus patients.
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Affiliation(s)
- Emily Figueiredo Neves Yuki
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Renata Soares
- Division of Central Laboratory, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Léonard de Vinci Kanda Kupa
- Division of Central Laboratory, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos Otto Heise
- Neurology Department, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nadia Emi Aikawa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Arnone
- Dermatology Department, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Romiti
- Dermatology Department, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tatiana do Nascimento Pedrosa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Clovis Artur Almeida da Silva
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra Gofinet Pasoto
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
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Touma Z, Cervera R, Brinks R, Lorenzoni V, Tani C, Hoyer BF, Costenbader KH, Sebastiani GD, Navarra SV, Bonfa E, Ramsey-Goldman R, Tedeschi SK, Dörner T, Johnson SR, Aringer M, Mosca M. Associations Between Classification Criteria Items in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 72:1820-1826. [PMID: 31560454 DOI: 10.1002/acr.24078] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 09/24/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE A project aimed at developing new classification criteria for systemic lupus erythematosus (SLE) is based on weighted criteria that include both laboratory and clinical items. Combinations of certain symptoms may occur commonly in SLE, which provides an argument against independently counting these items. The current study was undertaken to evaluate the interrelationship between candidate criteria items in the International Early SLE cohort and in the Euro-Lupus cohort. METHODS The International Early SLE cohort included 389 patients, who were diagnosed within 3 years prior to the study. Data on the ACR's 1997 update of the SLE revised criteria, the Systemic Lupus International Collaborating Clinics 2012 criteria, and on 30 additional items were collected. To evaluate the interrelationship of the criteria, a tetrachoric correlation was used to assess the degree of association between different manifestations in the same organ system. The correlations identified in the International Early SLE cohort were validated in the Euro-Lupus cohort. RESULTS A few relevant correlations were observed among specific clinical cutaneous manifestations (in particular, malar rash correlated with photosensitivity, alopecia, and oral ulcers) and serologic manifestations (anti-Sm and anti-double-stranded DNA and anti-RNA polymerase, anti-Ro and anti-La, and antiphospholipid antibodies), and these results were validated in the Euro-Lupus cohort. The associations within the mucocutaneous domain, hematologic and the specific autoantibodies suggest that within a single domain only the highest ranking item should be counted to avoid overrepresentation. CONCLUSION Some of the candidate SLE criteria cluster within domains. Given these interrelationships, multiple criteria within a domain should not be independently counted. These results are important to consider for the structure of new SLE classification criteria.
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Affiliation(s)
- Zahi Touma
- University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | - Bimba F Hoyer
- University Hospital Schleswig-Holstein, Kiel, Germany
| | | | | | | | - Eloisa Bonfa
- Hospital das Clínicas and Universidade de São Paulo, São Paulo, Brazil
| | | | - Sara K Tedeschi
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas Dörner
- Charité University Medicine Berlin and Deutsches Rheuma-Forschungszentrum, Berlin, Germany
| | - Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Martin Aringer
- University Medical Center and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Shimabuco AY, de Medeiros-Ribeiro AC, Miossi R, Bonfiglioli KR, de Moraes JCB, Gonçalves CR, Sampaio-Barros PD, Goldenstein-Schainberg C, de Souza FHC, do Prado LL, Ugolini-Lopes MR, Yuki EFVN, Bonfa E, Saad CGS. Ankylosing spondylitis and psoriatic arthritis: revisiting screening of latent tuberculosis infection and its follow-up during anti-tumor necrosis factor therapy in an endemic area. Clinics (Sao Paulo) 2020; 75:e1870. [PMID: 33146355 PMCID: PMC7561058 DOI: 10.6061/clinics/2020/e1870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/08/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To retrospectively evaluate the performance and distinctive pattern of latent tuberculosis (TB) infection (LTBI) screening and treatment in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) under anti-tumor necrosis factor (TNF) therapy and determine the relevance of re-exposure and other risk factors for TB development. METHODS A total of 135 and 83 patients with AS and PsA, respectively, were evaluated for LTBI treatment before receiving anti-TNF drugs via the tuberculin skin test (TST), chest radiography, and TB exposure history assessment. All subjects were evaluated for TB infection at 3-month intervals. RESULTS The patients with AS were more often treated for LTBI than were those with PsA (42% versus 30%, p=0.043). The former also presented a higher frequency of TST positivity (93% versus 64%, p=0.002), although they had a lower frequency of exposure history (18% versus 52%, p=0.027) and previous TB (0.7% versus 6%, p=0.03). During follow-up [median, 5.8 years; interquartile range (1QR), 2.2-9.0 years], 11/218 (5%) patients developed active TB (AS, n=7; PsA, n=4). TB re-exposure was the main cause in seven patients (64%) after 12 months of therapy (median, 21.9 months; IQR, 14.2-42.8 months) and five LTBI-negative patients. TB was identified within the first year in four patients (36.3%) (median, 5.3 months; IQR, 1.2-8.8 months), two of whom were LTBI-positive. There was no difference in the TB-free survival according to the anti-TNF drug type/class; neither synthetic drug nor prednisone use was related to TB occurrence (p>0.05). CONCLUSION Known re-exposure is the most critical factor for incident TB cases in spondyloarthritis. There are also some distinct features in AS and PsA LTBI screening, considering the higher frequency of LTBI and TST positivities in patients with AS. Annual risk reassessment taking into consideration these peculiar features and including the TST should be recommended for patients in endemic countries.
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Affiliation(s)
- Andrea Yukie Shimabuco
- Divisao de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, SP, BR
| | | | - Renata Miossi
- Divisao de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, SP, BR
| | | | | | | | | | | | | | - Leandro Lara do Prado
- Divisao de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, SP, BR
| | | | | | - Eloisa Bonfa
- Divisao de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, SP, BR
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Almaani S, Bhatt U, Arriens C, Bonfa E, Dall’Era M, Houssiau F, Kalunian K, Mackay M, Sanchez-Guerrero J, Solomons N, Rovin BH. Creatinine Fluctuation in Patients With Lupus Nephritis: Considerations for Clinical Trial Endpoints. Kidney Int Rep 2020; 5:1302-1305. [PMID: 32775830 PMCID: PMC7403554 DOI: 10.1016/j.ekir.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 01/21/2023] Open
Affiliation(s)
- Salem Almaani
- Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Correspondence: Salem Almaani, 395 West 12th Avenue, Ground Floor, Division of Nephrology, University Wexner Medical Center, Columbus, Ohio 43210, USA.
| | - Udayan Bhatt
- Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cristina Arriens
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Eloisa Bonfa
- Hospital das Clinicas da Universidade de Sao Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria Dall’Era
- Division of Rheumatology, University of California, San Francisco, California, USA
| | - Frederic Houssiau
- Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Brussels, Belgium
| | - Kenneth Kalunian
- Department of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Megan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York, USA
| | | | - Neil Solomons
- Aurinia Pharmaceuticals Inc., Victoria, British Columbia, Canada
| | - Brad H. Rovin
- Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Quintana R, Pons-Estel GJ, Roberts K, Sacnún M, Serrano R, Nieto R, Conti S, Gervasoni V, Catoggio LJ, Soriano ER, Scolnik M, García MA, Alvarellos A, Saurit V, Berbotto GA, Sato EI, Costallat LTL, Neto EFB, Bonfa E, Xavier RM, de Oliveira e Silva Montandon AC, Molina-Restrepo JF, Iglesias-Gamarra A, Guibert-Toledano M, Reyes-Llerena GA, Massardo L, Neira OJ, Cardiel MH, Barile-Fabris LA, Amigo MC, Silveira LH, Torre IGDL, Acevedo-Vásquez EM, Ugarte-Gil MF, Alfaro-Lozano JL, Segami MI, Chacón-Díaz R, Esteva-Spinetti MH, Gomez-Puerta JA, Alarcón GS, Pons-Estel BA. Clinical features, damage accrual, and survival in patients with familial systemic lupus erythematosus: data from a multi-ethnic, multinational Latin American lupus cohort. Lupus 2020; 29:1140-1145. [DOI: 10.1177/0961203320935184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives This study aimed to compare the clinical features, damage accrual, and survival of patients with familial and sporadic systemic lupus erythematosus (SLE). Methods A multi-ethnic, multinational Latin American SLE cohort was studied. Familial lupus was defined as patients with a first-degree SLE relative; these relatives were interviewed in person or by telephone. Clinical variables, disease activity, damage, and mortality were compared. Odds ratios (OR) and 95% confidence intervals (CI) were estimated. Hazard ratios (HR) were calculated using Cox proportional hazard adjusted for potential confounders for time to damage and mortality. Results A total of 66 (5.6%) patients had familial lupus, and 1110 (94.4%) had sporadic lupus. Both groups were predominantly female, of comparable age, and of similar ethnic distribution. Discoid lupus (OR = 1.97; 95% CI 1.08–3.60) and neurologic disorder (OR = 1.65; 95% CI 1.00–2.73) were significantly associated with familial SLE; pericarditis was negatively associated (OR = 0.35; 95% CI 0.14–0.87). The SLE Disease Activity Index and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) were similar in both groups, although the neuropsychiatric (45.4% vs. 33.5%; p = 0.04) and musculoskeletal (6.1% vs. 1.9%; p = 0.02) domains of the SDI were more frequent in familial lupus. They were not retained in the Cox models (by domains). Familial lupus was not significantly associated with damage accrual (HR = 0.69; 95% CI 0.30–1.55) or mortality (HR = 1.23; 95% CI 0.26–4.81). Conclusion Familial SLE is not characterized by a more severe form of disease than sporadic lupus. We also observed that familial SLE has a higher frequency of discoid lupus and neurologic manifestations and a lower frequency of pericarditis.
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Affiliation(s)
- Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Hospital Provincial de Rosario, Rosario, Argentina
| | - Guillermo J Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Hospital Provincial de Rosario, Rosario, Argentina
| | | | | | - Rosa Serrano
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Romina Nieto
- Hospital Provincial de Rosario, Rosario, Argentina
| | | | | | | | | | - Marina Scolnik
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mercedes A García
- Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
| | | | | | | | - Emilia I Sato
- Universidade Federal da Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | | | | | | | - Ricardo M Xavier
- Hospital da Clinicas da Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | | | | | | | | | | | - Loreto Massardo
- Facultad de Medicina, Universidad San Sebastián, Santiago, Chile
| | - Oscar J Neira
- Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Mario H Cardiel
- Centro de Investigación Clínica de Morelia SC, Morelia, Mexico
| | | | | | - Luis H Silveira
- Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | | | | | - Manuel F Ugarte-Gil
- Servicio de Reumatología, Hospital General Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | | | | | - Rosa Chacón-Díaz
- Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela
| | | | | | - Graciela S Alarcón
- The University of Alabama at Birmingham, Birmingham, USA
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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Carvalho JF, Viana VS, Leon EP, Bonfa E, Pasoto SG, Martins VR. RETRACTED: Antibodies to cellular prion protein and its cognate ligand stress-inducible protein 1 in systemic lupus erythematosus. Lupus 2020; 29:NP1-NP7. [PMID: 32588733 DOI: 10.1177/0961203320935987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jozélio F Carvalho
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vilma St Viana
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Elaine P Leon
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Sandra G Pasoto
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vilma R Martins
- Ludwig Institute for Cancer Research, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
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Dinis VG, Bonfiglioli K, Shimabuco A, Saad C, Domiciano DS, Moraes J, Neves E, Luppino-Assad A, Souza F, Carriço Da Silva H, Bonfa E, Medeiros-Ribeiro AC. THU0183 ABATACEPT AND LOW GAMMA-GLOBULIN LEVELS: NO ASSOCIATION WITH INFECTIOUS RISK OR RA DISEASE ACTIVITY CONTROL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Background:Abatacept (ABA) can induce decrease in gamma-globulins, but the long-term safety of such reduction is unknown. Moreover, it is suggested that such decrease is dissociated from disease activity response.Objectives:To evaluate ABA-induced gamma-globulins reduction and its correlation with disease activity control and the risk of infection in rheumatoid arthritis(RA) patients.Methods:This is a retrospective inception cohort of RA patients undergoing ABA for the first time in a large single tertiary cohort (2007 to 2019). Patients were evaluated regarding clinical and inflammatory data, total and specific (IgG, IgM, IgA) gamma-globulins assessed before, at 3 and 6 months, and then every 6 months up to discontinuation/censoring. The occurrence of severe or recurrent infections as cause of discontinuation of treatment was recorded. All patients were submitted to a systematic infectious screening protocol before and during treatment.Results:One hundred seventy-nine RA patients were included. They were predominantly female (93%;n=167) and had a positive rheumatoid factor (RF, 84%; n=151). Median(range) age and disease duration were 55.1(17-81.3) and 14(1.6-39.8) years, respectively. ABA was used in median as the 3rd(1-8) bDMARD. Most patients (74.3%, n=134) had already used a TNFi previously and 34.1% (n=61) had failed to rituximab. Baseline DAS28 [median(range)] was 4.9 (2-8.62), CDAI 27(5-66), HAQ 1.5 (0-3), ESR 18(2-111), and CRP 8.1(0.1 -135.7). Levels of total gamma-globulins(TGG) were 1.2 (0.5-2.8g/dL), IgG 1,094(422-2,785mg/dL), IgM104(19-405 mg/dL), and IgA 324 (100-739mg/dL). Forty-five patients (25.1%) had low IgG before ABA, but only 8(4.5%) had IgG<600mg/dL and low TGG. At 3 months, remarkable decreases were observed in total gamma-globulin(1.2vs.1.1g/dL), IgG(1,094vs.992mg/dL), IgM(104vs.93mg/dL), and IgA(324vs.302mg/dL), in comparison to baseline(p<0.05). Longitudinal measurements demonstrated that levels of gamma-globulins remained stable for subsequent evaluations(p>0.05). At baseline, TGG, IgG, IgM and IgA correlated positively to all disease activity parameters: DAS28(r=+0.33; r=+0.31;r=+0.24 and r=+0.37, respectively; p<0.02 for all), SDAI (r=+0.35; r=+0.37; r=+0.43; r=+0.34, respectively; p<0.04 for all), CDAI (r=+0.32; r=+0.29; r=+0.39; r=+0.31, respectively; p<0.03 for all, except IgA), swollen joints (r=+0.24; r=+0.23; p<0.01 only for TGG and IgG, respectively); tender joints (r=+0.18; r=+0.21; p<0.04 only for IgG and IgM respectively), ESR (r=+0.35; r=+0.24; r=+0.41; p<0.02 for TGG, IgG and IgA, respectively) and CRP (r=+0.20; r=+0.16; r=+0.27; p<0.05 for TGG, IgG and IgA, respectively). Longitudinally, most of these correlations were lost(p>0.05). Moreover, at 6 months, 25 patients (14%) achieved DAS28 ≤ 2.6 and 49 (27.4%) had low disease activity (DAS28 ≤ 3.2). Baseline or longitudinal measures of TTG and subtypes were similar among patients who responded and those who did not, regardless of the cut-off used(p>0.05. Only 14 patients (9.4%) had the medication discontinued due to infections: 3 due to recurrent infections and 11 to severe infections. One patient died. The frequencies of low IgG (under the normal limit of normality) at baseline and all time points(p>0.05) were similar among patients with and without severe/recurrent infections. None of these patients had low TGG or very low IgG(<600mg/dL) at baseline or during treatment and the levels of TGG and all subtypes were comparable at all time points (p>0.05).Conclusion:This cohort of real-world RA patients shows that reduction in gamma-globulin levels induced by ABA is safe, non-progressive and not associated to a higher risk of infection, even in patients with low IgG or TGG. Additionally, it is not associated to clinical response.Disclosure of Interests: None declared
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Fukuti P, Uchôa CLM, Mazzoco MF, Corchs F, Kamitsuji CS, Rossi LD, Rios IC, Lancman S, Bonfa E, Barros-Filho TEPD, Miguel EC. How Institutions Can Protect the Mental Health and Psychosocial Well-Being of Their Healthcare Workers in the Current COVID-19 Pandemic. Clinics (Sao Paulo) 2020. [DOI: 10.6061/clinics/2020/e1663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Pedrosa TN, Pasoto SG, Aikawa NE, Yuki EF, Borba EF, Filho JCF, Carricondo PC, Zanetti CB, Conde PG, Duarte NJ, Fontoura N, Romano P, Carvalho VM, Silva CA, Bonfa E. Understanding the dynamics of hydroxychloroquine blood levels in lupus nephritis. Lupus 2020; 29:560-568. [PMID: 32192398 DOI: 10.1177/0961203320912832] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objectives It is unknown if hydroxychloroquine blood level dynamics impact flare rates in lupus nephritis patients. We prospectively evaluated hydroxychloroquine levels to determine which blood-based patterns are more associated with disease activity. Methods In total, 82 lupus nephritis patients under a prescribed hydroxychloroquine dose of 4–5.5 mg/kg actual body weight (maximum 400 mg/day) for ≥3 months were evaluated at baseline and 7 months. Hydroxychloroquine blood levels were determined by liquid chromatography-tandem mass spectrometry. Flare was defined as increase ≥3 in the Systemic Lupus Erythematosus Disease Activity Index 2000 score and/or a change or increase in therapy. Results Overall, 9/82(11%) patients had flares during follow-up and had lower baseline hydroxychloroquine blood levels than those without flares (220.4 (53.5–1471.1) vs. 1006.3 (53.5–2137.8) ng/ml, p = 0.013). The hydroxychloroquine blood level cut-off that best predicted flares was 613.5 ng/ml (odds ratio = 8.67, 95% confidence interval: 1.66–45.18, p = 0.006). For 77 (94%) patients, the 7-month hydroxychloroquine level dynamics was evaluated and revealed: 59/77 (77%) had a persistent pattern of adequate (41/77(53%)) or fluctuating (18/77 (23%)) levels, with a low and comparable risk of flares (2/41 (5%) vs. 1/18 (5%), p = 1.000). The remaining group had persistent low levels (18/77 (23%)) and their flare frequency was significantly higher than the adequate group (5/18 (28%) vs. 2/41 (5%), p = 0.023). The frequencies of adequate/inadequate hydroxychloroquine blood levels in patients were comparable at baseline and 7 months (McNemar’s test, p = 0.480). Conclusion We provide novel evidence that hydroxychloroquine blood-level patterns (persistently low, adequate, or intermittent) have distinct impacts on flare rates in lupus nephritis patients. These findings reinforce the need of routine hydroxychloroquine measurements to maintain the appropriate blood levels.
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Affiliation(s)
- Tatiana N Pedrosa
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nadia E Aikawa
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.,Pediatric Rheumatology Unit, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Emily Fn Yuki
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eduardo F Borba
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Julio Cr Ferreira Filho
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.,Division of Central Laboratory, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Pedro C Carricondo
- Ophtalmology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Caio B Zanetti
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paola G Conde
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nilo Jc Duarte
- Division of Central Laboratory, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nicole Fontoura
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paschoalina Romano
- Division of Central Laboratory, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Clovis A Silva
- Pediatric Rheumatology Unit, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
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Marcilio I, Miethke-Morais A, Harima L, Montal AC, Perondi B, Ayres JRDCM, Gouveia N, Bonfa E, Novaes HMD. Epidemiologic Surveillance in an academic hospital during the COVID-19 pandemic in Sao Paulo, Brazil: the key role of epidemiologic engagement in operational processes. Clinics (Sao Paulo) 2020; 75:e2166. [PMID: 32725077 PMCID: PMC7362715 DOI: 10.6061/clinics/2020/e2166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/01/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Izabel Marcilio
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Anna Miethke-Morais
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Leila Harima
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Amanda C. Montal
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Beatriz Perondi
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Nelson Gouveia
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, SP, BR
| | - Eloisa Bonfa
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Fukuti P, Uchôa CLM, Mazzoco MF, Corchs F, Kamitsuji CS, Rossi LD, Rios IC, Lancman S, Bonfa E, de Barros-Filho TEP, Miguel EC. How Institutions Can Protect the Mental Health and Psychosocial Well-Being of Their Healthcare Workers in the Current COVID-19 Pandemic. Clinics (Sao Paulo) 2020; 75:e1963. [PMID: 32520224 PMCID: PMC7247736 DOI: 10.6061/clinics/2020/e1963] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Pedro Fukuti
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Marina Flaborea Mazzoco
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Felipe Corchs
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Luciane De Rossi
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Izabel Cristina Rios
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Selma Lancman
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Eloisa Bonfa
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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