AB0365 CLINICAL, LABORATORY AND IMAGING OUTCOMES IN TOCILIZUMAB-TREATED PATIENTS WITH LARGE VESSEL-GIANT CELL ARTERITIS ACCORDING TO EARLY ONSET THERAPY

Autor: Roman Blanco, F. J. Gomez de la Fuente, Belén Atienza-Mateo, M. A. González-Gay, Aida Sánchez-Salmón, Diana Prieto-Peña, Oriana Cuenca-Vera, Isabel Martínez-Rodríguez
Rok vydání: 2021
Předmět:
Zdroj: Annals of the Rheumatic Diseases. 80:1208.1-1208
ISSN: 1468-2060
0003-4967
DOI: 10.1136/annrheumdis-2021-eular.1733
Popis: Background:Tocilizumab (TCZ) has shown efficacy in large vessel vasculitis (LVV)-Giant Cell Arteritis (LVV-GCA) (1-2). 18F-fluodeoxyglucose positron emission tomography (18F-FDG PET/CT) is useful to assess LVV disease activity (3-5). It is unknown if early treatment with TCZ may have an influence on clinical, laboratory and imaging outcomes.Objectives:To assess clinical, laboratory and PET/CT activity improvement in LVV-GCA patients treated with TCZ according to the time from disease diagnosis to TCZ onset.Methods:Comparative single-center study of 30 LVV-GCA patients treated with TCZ who were divided into 2 groups depending on the time of onset of TCZ: a) early onset (≤ 6 months; n=15) and b) late onset (> 6 months; n=15). All patients had a baseline and a follow-up PET/CT scan. Complete clinical improvement and normalization of laboratory markers (CRP ≤0.5mg/dL and/or ESR ≤ 20 mm/1st hour) was assessed. For imaging evaluation, normalization of total visual score (TVS) was considered when TVS = 0 and normalization of semiquantitative activity if the target to background ratio (TBR) at the thoracic aorta was Results:30 patients were included (24 women/6 men); mean age 65.7± 9.8 years. Patients in the TCZ early-onset group were receiving higher doses of prednisone (10.0[5.9-15.0] vs 5.0 [5.0-7.5] mg/day; p< 0.01) and had higher TVS scores (7.0 [4.0-9.0] vs 3.0 [2.0-5.0]; p< 0.01) at baseline (Table 1). Following TCZ initiation, after a mean of 10.8±3.7 months, most patients achieved complete clinical improvement and normalization of ESR and CRP in both groups. Uncoupling with imaging outcomes was observed in both groups. Although non-significant statistical differences were observed, complete TBR normalization (TBR Table 1.Early-onset TCZ therapy(n= 15)Late-onset TCZ therapy(n=15)pGeneral featuresAge (years), mean ± SD65.8 ± 9.965.5 ± 10.10.94Sex (female), n (%)11 (73.3)13 (86.7)0.65GCA evolution before TCZ onset, median [IQR]2.0 [1.0-5.0]18.0 [9.0-34.0]< 0.01LaboratoryESR (mm/1st hour), mean ± SD34.7 ± 26.330.8 ± 28.70.70CRP (mg/dL), median [IQR]1.1 [0.6-2.3]0.8 [1.8 -2.5]0.28Prednisone dose (mg/day), mean ± SD10.0 [5.9-15.0]5.0 [5.0-7.5]0.01TCZ therapyIntravenous, n (%)10 (66.7)11(73.3)0.99Combined with MTX, n(%)6 (40)8 (53.3)0.46PET /CT activityTBR at thoracic aorta1.86 ± 0.691.54 ± 0.180.09TVS7.0 [4.0-9.0]3.0 [2.0-5.0]< 0.01Complete clinical improvement, n (%)13 (86.7)12 (80)0.99Normalization of ESR and CRP, n (%)15 (100)15 (100)0.99PET/CT improvementComplete TBR normalization6 (40)3 (20)0.23Complete TVS normalization2 (13.3)1 (6.7)0.54CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; TBR: target-to-background ratio. * Normalization of TBR was considered when TBR < 1.34. ** Normalization of TVS was considered when TVS=0.Conclusion:TCZ was effective in patients with LVV-GCA regardless the time from disease diagnosis to TCZ onset. However, complete normalization of vascular activity in PET/CT scans tended to occur more likely in patients who receive early-onset TCZ therapy within the first 6 months of the disease.References:[1]Calderón-Goercke M et al. Semin Arthritis Rheum. 2019; 49:126-135. PMID: 30655091[2]Prieto Peña D et al. Clin Exp Rheumatol. 2020. PMID: 33253103[3]González-Gay MA et al. Expert Rev Clin Immunol. 2018; 14:593-605. PMID: 29877748[4]Martínez-Rodríguez et al. Semin Arthritis Rheum.2018; 47(4): 530-537. PMID: 28967430[5]Prieto-Peña D et al. Semin Arthritis Rheum. 2019; 48:720-727. PMID: 28967430Disclosure of Interests:Diana Prieto-Peña Grant/research support from: UCB Pharma, Roche, Sanofi, Pfizer, AbbVie and Lilly, Isabel Martínez-Rodríguez: None declared, Belén Atienza-Mateo: None declared, Oriana Cuenca-Vera: None declared, Francisco Javier Gomez de la Fuente: None declared, Aida Sanchez-Salmón: None declared, Miguel A González-Gay Grant/research support from: Abbvie, MSD, Jansen and Roche and had consultation fees/participation in company sponsored speaker´s bureau from Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, and had consultation fees/participation in company sponsored speaker´s bureau from Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD
Databáze: OpenAIRE
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