A Delphi Exercise Informing the Development of Criteria to Measure Response to Treatment in Giant Cell Arteritis

Medha Soowamber¹, Milena Bond², Catalina Sanchez Alvarez³, Carol Langford⁴, Sibel Aydin⁵, FRANK BUTTGEREIT⁶, Dario Camellino⁷, Maria Cid⁸, Peter Grayson⁹, Bernhard Hellmich¹⁰, Tanaz Kermani¹¹, Nader Khalidi¹², Sarah Mackie¹³, Alfred Mahr¹⁴, Eric L Matteson³, Mehrdad Maz¹⁵, Peter Merkel¹⁶, Paul Monach¹⁷, Lorna Neill¹⁸, Cristina Ponte¹⁹, Carlo Salvarani²⁰, Wolfgang Schmidt²¹, Peter Villiger²², Kenneth Warrington²³, Christian Dejaco²⁴, Sofia Ramiro²⁵ and Zahi Touma²⁶, ¹Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, ²South Tyrol Health Trust and Teaching Hospital of the Paracelsus Medical University, Brunico, Italy, ³Mayo Clinic College of Medicine and Science, Rochester, MN, ⁴Cleveland Clinic, Moreland Hills, OH, ⁵Department of Medicine, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, ON, Canada, ⁶Charité University Medicine Berlin, Berlin, Berlin, Germany, ⁷"La Colletta" hospital, Azienda Sanitaria Locale ³ Genovese, Arenzano, Italy, ⁸Department of Autoimmune Diseases (member of European Reference Network RITA), Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, ⁹National Institutes of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Chevy Chase, MD, ¹⁰Department of Internal Medicine, Rheumatology, Pulmonology, Nephrology and Diabetology, Medius Kliniken Kirchheim/Teck, University Tübingen, Tübingen, Germany, Kirchheim-Teck, Germany, ¹¹David Geffen School of Medicine, University of California, Los Angeles, CA, ¹²Department of Medicine, McMaster University and St. Joseph’s Healthcare, Hamilton, Canada, ¹³University of Leeds, Leeds, United Kingdom, ¹⁴Klinik für Rheumatologie, Kantonspital St Gallen, St Gallen, Switzerland, ¹⁵The University of Kansas Medical Center, Kansas City, KS, ¹⁶University of Pennsylvania, Philadelphia, PA, ¹⁷VA Boston Healthcare System, Boston, MA, ¹⁸Patient Charity Polymyalgia Rheumatica and Giant Cell Arteritis Scotland, Nethy Bridge, United Kingdom, ¹⁹Unidade Local de Saúde de Santa Maria, Lisbon, Portugal, ²⁰Unit of Rheumatology, Azienda USL - IRCCS di Reggio Emilia, and University of Modena and Reggio Emilia, Reggio Emilia, Italy, ²¹Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch; Waldfriede Hospital, Rheumatology, Berlin, Germany, ²²Medical Center Monbijou, Rheumatology and Clinical Immunology, Bern, Switzerland, ²³Mayo Clinic, ROCHESTER, MN, ²⁴Medical University of Graz, Graz, Austria, ²⁵Leiden University Medical Center, Bunde, Netherlands, ²⁶University of Toronto, Toronto, ON, Canada

Meeting: ACR Convergence 2025

Keywords: giant cell arteritis, Qualitative Research, Vasculitis

Session Information

Date: Monday, October 27, 2025

Title: (1612–1632) Vasculitis – Non-ANCA-Associated & Related Disorders Poster II

Session Type: Poster Session B

Session Time: 10:30AM-12:30PM

Background/Purpose: The therapeutic landscape of giant cell arteritis (GCA) is growing rapidly but there are currently no internationally standardized criteria for assessing response to treatment in GCA. To address this issue, there is an ongoing project to develop response criteria for GCA, supported by European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology (ACR). Following a systematic literature review (SLR), a Delphi exercise was conducted to determine items that might be included in the future response criteria. The goal of this Delphi exercise was to identify the most important and relevant items to consider when developing criteria to measure response to treatment in GCA.

Methods: A four-round web-based Delphi exercise was conducted. Participants from 38 countries included patients with GCA and physicians with expertise in GCA. They rated the importance (1=lowest, 9=highest) of 51 items from a prior SLR, grouped into six domains, and suggested additional items. Items obtaining a score of 7-9 by at least 70% of physicians and 70% of patients were considered critically important and to have reached consensus for inclusion. Items which scored 1-3 by 70% of physicians and patients were considered not important and excluded from subsequent rounds. In a 4th round of the Delphi (ranking round), participants selected and ranked the 10 most relevant items from those deemed most important in the previous three rounds. A task force (n=32 members) meeting followed to review the Delphi results, discuss rankings, and finalize the selection of items.

Results: A total of 187 physicians and 85 patients participated in the Delphi exercise. Thirteen new items were proposed in round 1. Twenty-four items were rated as critically important (18 in round 1, 5 in round 2, 1 in round 3) by ≥70% of patients and ≥70% of physicians (Figure 1). These items covered the six domains of the Delphi (Figure 1): 10 for clinical, 2 for laboratory, 5 for imaging, 3 for treatment, 1 for patient-reported outcomes and 3 for damage. No items were excluded during any round, and consensus was not reached for 40 items. The top three highest-rated items by both patients and physicians were headache (ranked highest by 52% of patients and physicians), amaurosis fugax (ranked highest by 10%), and jaw claudication (ranked highest by 7%).Of the task force members, 24/32 (75%) participated in the virtual task force meeting. Among the items discussed by the task force (Figure 1), glucocorticoid-related parameters were excluded as they were considered indirect indicators of response to treatment. Constitutional symptoms were added by the task force as they are important constellation of symptoms seen in GCA. The task force also decided to cluster items with similar constructs to capture the spectrum of the disease more concisely. 12 items were selected for the next phase of the project (Figure 2).

Conclusion: This Delphi exercise identified a set of 12 items within 6 domains as being relevant towards measuring response in GCA. These 12 items will be used in a subsequent group conjoint analysis to further prioritize and weigh potential items for inclusion in a draft set of criteria to measure treatment response in GCA.

Disclosures: M. Soowamber: AbbVie/Abbott, 6; M. Bond: AbbVie/Abbott, 6; C. Sanchez Alvarez: None; C. Langford: AbbVie/Abbott, 12, Non-paid consultant, AstraZeneca, 5, 12, Non-paid consultant, Bristol-Myers Squibb(BMS), 5, 12, Non-paid consultant, GlaxoSmithKlein(GSK), 5, NS Pharma, 5; S. Aydin: AbbVie/Abbott, 5, 6, Eli Lilly, 5, 6, Janssen, 5, 6, Novartis, 5, 6, Pfizer, 5, 6, UCB, 5, 6; F. BUTTGEREIT: Abbvie, 2, 5, 6, Biogen, 5, 6, Eli Lilly, 5, 6, Galapagos, 5, 6, grant support, consultancy fees, honoraria and travel expenses from Abbvie, Pfizer, Gruenenthal, and Horizon Therapeutics, all unrelated, 12, grant support, consultancy fees, honoraria and travel expenses from Abbvie, Pfizer, Gruenenthal, and Horizon Therapeutics, all unrelated, Janssen, 6, Medac, 5, 6, Novartis, 1, 6, pf, 5, 6, Roche, 6, Sanofi, 5, 6; D. Camellino: AstraZeneca, 6, Boehringer-Ingelheim, 6, GlaxoSmithKlein(GSK), 6, Janssen, 6; M. Cid: AbbVie, 2, 6, AstraZeneca, 2, 6, Boehringer-Ingelheim, 2, CSL-Vifor, 2, 6, GSK, 2, 6, Kiniksa Pharmaceuticals, 5, UpToDate, 9; P. Grayson: None; B. Hellmich: AbbVie/Abbott, 1, 6, AstraZeneca, 1, 6, Boehringer-Ingelheim, 1, 6, CSL Vifor, 1, 6, GlaxoSmithKlein(GSK), 1, 6, Novartis, 1, 6, Pfizer, 6; T. Kermani: None; N. Khalidi: AbbVie/Abbott, 2, 5, 5, 6, Bristol-Myers Squibb(BMS), 2, 5, 5, GlaxoSmithKlein(GSK), 2, 6, Mallinckrodt, 2, NS Pharma, 5, Otsuka, 2, 6, Roche, 2, 6, Sanofi, 2, 5; S. Mackie: AbbVie/Abbott, 2, 6, AstraZeneca, 2, Fresenius Kabi, 6, Novartis, 6, Pfizer, 2, 6, Roche, 2, 6, Sanofi, 2, UCB, 6, Vifor, 6; A. Mahr: None; E. Matteson: Amgen, 4, Boehringer-Ingelheim, 2, 6, HorizonTherapeutics, 4; M. Maz: None; P. Merkel: AbbVie, 2, 5, Alpine, 2, Amgen, 2, 5, ArGenx, 2, AstraZeneca, 2, 5, Boehringer-Ingelheim, 2, 5, Bristol-Myers Squibb (BMS), 2, 5, CSL Behring, 2, Eicos, 5, Electra, 5, GlaxoSmithKlein (GSK), 2, 5, iCell, 2, Interius, 2, Kinevant, 2, Kyverna, 2, 11, Lifordi, 11, Metagenomia, 2, Neutrolis, 2, 5, 11, Novartis, 2, NS Pharma, 2, Otsuka, 2, Q32, 2, 11, Quell, 2, Regeneron, 2, Sanofi, 2, Sparrow, 2, 11, Takeda, 2, 5, UpToDate, 9, Vistera, 2; P. Monach: Boehringer-Ingelheim, 2; L. Neill: None; C. Ponte: AbbVie/Abbott, 2, 4, 6, CSL Vifor, 2, 4, 6, GlaxoSmithKlein(GSK), 2, 6, Novartis, 5, 6, Pfizer, 6; C. Salvarani: None; W. Schmidt: AbbVie, 1, 5, 6, Alfasigma, 6, Amgen, 6, Boehringer-Ingelheim, 1, Chugai, 6, Eli Lilly, 6, Fresenius Kabi, 1, GlaxoSmithKline, 6, Medac, 6, Novartis, 1, 5, 6, Pfizer, 6, UCB, 6; P. Villiger: None; K. Warrington: Bristol-Myers Squibb(BMS), 5, Sanofi, 2; C. Dejaco: AbbVie/Abbott, 2, 5, 6, Eli Lilly and Company, 2, 6, Janssen Pharmaceuticals Inc, 2, 6, Novartis, 2, 5, 6, Pfizer, 2, 6, Roche, 2, 6, Sanofi, 2, 6, Sparrow Pharmaceuticals, 2, 6; S. Ramiro: AbbVie, 2, 5, Eli Lilly, 2, 5, Galapagos/Alfasigma, 2, 5, Janssen, 2, MSD, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, Sanofi, 2, 5, UCB, 2, 5; Z. Touma: AbbVie, 2, AstraZeneca, 1, 2, 5, GSK, 2, 5, Merck KgaA, 2, Novartis, 1, Roche, 2, Sarkana Pharma Inc, 2, UCB/Biopharma, 1, 2.

To cite this abstract in AMA style:

Soowamber M, Bond M, Sanchez Alvarez C, Langford C, Aydin S, BUTTGEREIT F, Camellino D, Cid M, Grayson P, Hellmich B, Kermani T, Khalidi N, Mackie S, Mahr A, Matteson E, Maz M, Merkel P, Monach P, Neill L, Ponte C, Salvarani C, Schmidt W, Villiger P, Warrington K, Dejaco C, Ramiro S, Touma Z. A Delphi Exercise Informing the Development of Criteria to Measure Response to Treatment in Giant Cell Arteritis [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/a-delphi-exercise-informing-the-development-of-criteria-to-measure-response-to-treatment-in-giant-cell-arteritis/. Accessed .

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