ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 0849

Effectiveness of Tocilizumab in Aortitis and Aneurysms Associated with Giant Cell Arteritis. Multicenter Open-label Study

Adrián Martín-Gutiérrez1, Javier Loricera2, Carmen Secada Gómez3, Iñigo Hernández-Rodríguez4, Susana Romero Yuste5, Eugenio De Miguel6, Eva Galindez-Agirregoikoa7, ivan Ferraz-Amaro8, Julio Sánchez-Martín9, Patricia Moya Albarado10, Cristina Campos Fernández11, Fernando Lopez-Gutierrez12, Santos Castañeda13 and Ricardo Blanco-Alonso14, and the Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group, 1Hospital Universitario Marques de Valdecilla, IDIVAL, Renedo de Piélagos, Cantabria, Spain, 2Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, 3Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, 4Complejo Hospitalario Universitario de Vigo, Vigo, Spain, 5Department of Rheumatology, University Hospital Complex of Pontevedra, Pontevedra, Spain, 6Hospital Universitario La Paz, Madrid, Spain, 7BASURTO UNIVERSITY HOSPITAL, BILBAO, Spain, 8Rheumatology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canarias, Spain, 9Hospital Universitario 12 de Octubre, Madrid, Spain, 10Hospital de San Pau, Barcelona, Spain, 11Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain, 12Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain, 13Hospital Universitario de la Princesa, Madrid, Spain, 14Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Immunopathology group, Santander, Spain

Meeting: ACR Convergence 2024

Keywords: , , , ,

Session Information

Date: Saturday, November 16, 2024

Title: Abstracts: Imaging of Rheumatic Diseases

Session Type: Abstract Session

Session Time: 3:00PM-4:30PM

Background/Purpose: Giant Cell Arteritis (GCA) was initially described involving mainly the extracranial branches of the carotid arteries. However, GCA also may involve the aorta (GCA-aortitis) and its major branches, that may lead to severe complications such as aortic aneurysms, with the consequent risk of dissection with a high mortality. Tocilizumab (TCZ) was approved in GCA, but the efficacy in GCA-aortitis and aneurysms has not been specifically analyzed.
The aim is to assess the effectiveness and safety of TCZ in a wide series of GCA-aortitis and aneurysms.

Methods: Multicentre observational study with GCA-aortitis treated with TCZ. GCA was diagnosed by: a) ACR criteria, b) temporal artery biopsy, and/or c) imaging techniques. Aortitis was diagnosed mainly by PET/CT. Main outcomes were: 1) effectiveness of TCZ in GCA-aortitis, 2) in preventing the growth of GCA-aortitis aneurysm and 3) the development of new aneurysms. EULAR remission is the absence of clinical symptoms and systemic inflammation and imaging remission is considered when vascular FDG uptake was less than liver uptake in PET/CT.

Results: 471 patients with GCA treated with TCZ were reviewed. 196 of them had aortitis. We focused on 95 patients which had a baseline and follow-up imaging test. Figure 1. After 6 months, 60 (74.1%) reached EULAR remission but only, 1 (10%) an imaging remission; increasing up-to 83.3% and 27.5%, respectively, at 24 months. Figure 2. Aneurysms were present in 10 of 196 (5.1%) patients. Of the remaining patients without aneurysm, no patient on TCZ therapy developed aneurysms during follow-up.

Conclusion: In GCA-aortitis patients treated with TCZ, a rapid and maintained clinical and analytical improvement was observed. However, there was an uncoupling between clinical and EULAR remission with imaging remission. Moreover, TCZ does not seem to prevent aneurysm growth in those with structural damage already stablished.

Supporting image 1

Abbreviations: CRP: C-reactive protein; ESR: erythrocyte sedimentation rate, GCA: giant cell arteritis, IQR: interquartile range, PmR: polymyalgia rheumatica; SD: standard deviation, TCZcombo: tocilizumab in combination with synthetic immunosuppressants (besides corticosteroids), TCZmono: tocilizumab in monotherapy (besides corticosteroids).

Supporting image 2

(A) Serum C-reactive protein (CRP) (mg/dl); (B) Prednisone dose (mg/day); (C) EULAR, imaging, and complete remission in patients with GCA- aortitis (D) Imaging improvement at the last imaging test between aneurysm and non-aneurysm GCA- aortitis.
+ : no significant differences.
* : p<0.05.
** : p<0.0001.
¡ : few data, statistical analysis not possible.

Disclosures: A. Martín-Gutiérrez: None; J. Loricera: AstraZeneca, 2, 6, Celgene, 2, 6, Eli Lilly, 5, Janssen, 5, Merck/MSD, 2, 5, 6, Novartis, 12, Formation/Congress attendance, Pfizer, 5, Roche, 2, 5, 6, UCB, 2, 5, 6; C. Secada Gómez: None; I. Hernández-Rodríguez: None; S. Romero Yuste: AstraZeneca, 5; E. De Miguel: AbbVie/Abbott, 5, 6, BMS, 5, 6, Eli Lilly, 5, 6, Grunental, 5, 6, Janssen, 5, 6, Merck/MSD, 5, 6, Novartis, 5, 6, Pfizer, 5, 6, Roche, 5, 6, sanofi, 5, 6, UCB, 5, 6; E. Galindez-Agirregoikoa: AbbVie/Abbott, 6, Amgen, 6, Eli Lilly, 6, Janssen, 6, Novartis, 6, Pfizer, 6, UCB, 6; i. Ferraz-Amaro: AbbVie/Abbott, 5, 6, Celgene, 6, Janssen, 5, Merck/MSD, 5, 6, Pfizer, 6, Roche, 5, 6, sanofi, 6; J. Sánchez-Martín: None; P. Moya Albarado: None; C. Campos Fernández: None; F. Lopez-Gutierrez: AstraZeneca, 12, Formation/Congress attendance, 12, Formation/Congress attendance, Novartis, 12, Formation/congress attendance; S. Castañeda: Bristol-Myers Squibb(BMS), 2, 6, Eli Lilly, 2, 6, Merck/MSD, 2, 5, 6, Pfizer, 5, Roche, 2, 6, UCB, 2, 5; R. Blanco-Alonso: AbbVie, 2, 5, 6, Bristol-Myers Squibb, 2, 6, Galapagos, 6, Janssen, 2, 6, Lilly, 2, 6, MSD, 2, 5, 6, Pfizer, 2, 6, Roche, 2, 5, 6.

To cite this abstract in AMA style:

Martín-Gutiérrez A, Loricera J, Secada Gómez C, Hernández-Rodríguez I, Romero Yuste S, De Miguel E, Galindez-Agirregoikoa E, Ferraz-Amaro i, Sánchez-Martín J, Moya Albarado P, Campos Fernández C, Lopez-Gutierrez F, Castañeda S, Blanco-Alonso R. Effectiveness of Tocilizumab in Aortitis and Aneurysms Associated with Giant Cell Arteritis. Multicenter Open-label Study [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/effectiveness-of-tocilizumab-in-aortitis-and-aneurysms-associated-with-giant-cell-arteritis-multicenter-open-label-study/. Accessed .

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