Effect of Specific Treatments on Clinical, Serologic, and Imaging Assessments of Disease Activity in Large-Vessel Vasculitis

Shubhasree Banerjee¹, Kaitlin Quinn², Katherine B. Gribbons³, Joel S. Rosenblum⁴, Ali Civelek⁵, Elaine Novakovich⁶, Armin Bagheri¹, Peter A. Merkel⁷, Mark A. Ahlman⁸ and Peter C. Grayson⁹, ¹Systemic Autoimmunity Branch, NIAMS, NIH, Bethesda, MD, ²Systemic Autoimmunity Branch, NIAMS, Bethesda, MD, ³Systemic Autoimmunity Branch, National Institute of Arthritis and Skin and Musculoskeletal Disease, Bethesda, MD, ⁴NIAMS, National Institute of Arthritis, Musculoskeletal and Skin Disease (NIAMS), Bethesda, MD, ⁵National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, MD, ⁶National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, ⁷University of Pennsylvania, Philadelphia, PA, ⁸Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, ⁹National Institute of Arthritis, Musculoskeletal and Skin Disease, National Institutes of Health, Bethesda, MD

Meeting: ACR/ARHP Annual Meeting 2018

Keywords: large vessel vasculitis, positron emission tomography (PET) and treatment

Session Information

Date: Tuesday, October 23, 2018

Title: Vasculitis Poster III: Immunosuppressive Therapy in Giant Cell Arteritis and Polymyalgia Rheumatica

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Disease activity in large vessel vasculitis (LVV) is traditionally assessed by clinical and serologic (ESR, CRP) parameters. Imaging assessment, including ¹⁸F-fluorodeoxyglucose-positron emission tomography (FDG-PET), may be useful to monitor LVV. The study objective was to determine the impact of tocilizumab, infliximab and methotrexate (MTX) on disease activity in LVV as assessed by clinical, serologic, and imaging-based parameters.

Methods:

Patients with GCA or TAK were recruited into a prospective, observational cohort involving ≥2 FDG-PET/CT scans at 6-month intervals. Clinical assessment [physician global assessment (PGA, range 0-10)], serologic assessment (CRP-mg/L, ESR-mm/hr), and imaging assessment [PET Vascular Activity Score (PETVAS)] was determined at each visit. PETVAS is a global summary score of arterial FDG uptake assessed qualitatively relative to liver activity in 9 vascular beds, ranging from 0 to 27 with higher scores indicating more vascular inflammation. Clinical and imaging assessments were performed blinded to each other. Wilcoxon signed rank test was used to compare changes in PGA, CRP, ESR, and PETVAS between interval visits in response to treatments.

Results:

Fourteen subjects with GCA were treated with tocilizumab. Prior to treatment, every patient had clinical and PET scan activity. There was significant reduction in PGA (2.5 vs 0, p<0.01), CRP (6.8 vs 0.5, p<0.01), ESR (22.5 vs 4.5, p<0.01), and PETVAS (25.0 vs 22.0, p=0.01). PETVAS improved in 5 of 7 patients with GCA treated with tocilizumab. Despite significant improvement in PETVAS, only 2 of 14 patients (14%) had normalization of PET activity after treatment with tocilizumab. In contrast, clinical remission after tocilizumab occurred in most of these patients (n=10;71%). Most of the subjects were on glucocorticoids (GCs) and there was significant reduction the daily GC dose (p=0.01) at follow up.

Six subjects with TAK were treated with infliximab. All of them had clinically active disease and active PET scan at baseline. There was significant improvement in PGA (5.5 vs 2, p=0.03); however, four of six patients (67%) continued to have clinically active disease at follow up. All six patients had an improvement in PETVAS (21.0 vs 14.5, p=0.03). However, four of the six patients continued to have active vasculitis by PET at follow-up despite treatment and there was no significant change in CRP (24.9 vs 4.9, p=0.31) or ESR (32.5 vs 18.5, p=0.13). Daily GC dose was similar at baseline and follow up (p=0.5).

Treatment with MTX was studied in 12 patients (TAK=3, GCA=9). Variable response to MTX was observed without significant change in PGA (3 vs 0, p=0.09), CPR (5.8 vs 3.5, p=0.18), ESR (31 vs 19.5, p=0.33), or PETVAS (24 vs 18, p=0.31).

Conclusion:

Imaging and clinical assessment of disease activity significantly improved but rarely normalized in response to tocilizumab in GCA and TNF inhibitors in TAK. In contrast, methotrexate did not consistently improve clinical or imaging-based assessments of disease activity in LVV. These findings support a need to study the value of FDG-PET as a surrogate outcome measure of vascular activity in randomized clinical trials in LVV.

Disclosure: S. Banerjee, None; K. Quinn, None; K. B. Gribbons, None; J. S. Rosenblum, None; A. Civelek, None; E. Novakovich, None; A. Bagheri, None; P. A. Merkel, None; M. A. Ahlman, None; P. C. Grayson, None.

To cite this abstract in AMA style:

Banerjee S, Quinn K, Gribbons KB, Rosenblum JS, Civelek A, Novakovich E, Bagheri A, Merkel PA, Ahlman MA, Grayson PC. Effect of Specific Treatments on Clinical, Serologic, and Imaging Assessments of Disease Activity in Large-Vessel Vasculitis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/effect-of-specific-treatments-on-clinical-serologic-and-imaging-assessments-of-disease-activity-in-large-vessel-vasculitis/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-specific-treatments-on-clinical-serologic-and-imaging-assessments-of-disease-activity-in-large-vessel-vasculitis/