Efficacy & Safety of Tocilizumab in Giant Cell Arteritis: A Single Centre NHS Experience Using Imaging (Ultrasound and PET CT) as a Diagnostic and Monitoring Tool

Alwin Sebastian¹, Abdul Kayani¹, Diana Prieto-Peña², Alessandro Tomelleri³, Madeline Whitlock¹, Kornelis S. M. van der Geest⁴ and Bhaskar Dasgupta¹, ¹Rheumatology, Mid and South Essex University Hospital NHS Foundation Trust, Southend University Hospital, United Kingdom, Westcliff on sea, England, United Kingdom, ²Research group on genetic epidemiology and atherosclerosis in systemic diseases and in metabolic bone diseases of the musculoskeletal system, IDIVAL; and Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain, ³Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy, Milan, Italy, ⁴Rheumatology and Clinical Immunology, University Medical Center Groningen, Netherlands, Groningen, Netherlands

Meeting: ACR Convergence 2020

Keywords: giant cell arteritis, Ultrasound, Vasculitis

Session Information

Date: Monday, November 9, 2020

Title: Vasculitis – Non-ANCA-Associated & Related Disorders Poster II

Session Type: Poster Session D

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

Background/Purpose: Tocilizumab (TCZ), an IL-6 receptor blocker is approved to treat relapsing, refractory Giant cell arteritis (GCA) We here report our real-life clinical experience with the the efficacy and safety of TCZ in GCA. Furthermore, we assessed the effect of TCZ on imaging, i.e. ultrasound (US) and FDG-PET/CT, during the first year of treatment.

Methods: We included 22 consecutive patients with GCA, who were treated with TCZ. EULAR core data set was collected since July 2018. Data on disease activity, quality of life and treatment-related complications were collected. Pre-TCZ ultrasound and FDG-PET/CT findings were available for 21 patients and 4 patients, respectively. The effect of TCZ on the following parameters was determined: US halo thickness (n=21), US Temporal Artery Halo Score (n=5), US Axillary Artery Halo Score (n=8) and Total Vascular Score on FDG-PET/CT (n=4)

Results: The 22 patients with GCA (10 cranial GCA, 10 large vessel GCA, 2 cranial/large vessel GCA) had a median disease duration of 58.5 weeks (range 1-370) prior to initiation of TCZ. Half of patient had used prior csDMARD treatment. TCZ was indicated due to refractory (50%), ischemic (36%) or relapsing (14%) disease. Median follow up was 43 weeks (IQR 12-52). TCZ was discontinued due to SAEs in ?? patients. Upon treatment with TCZ, 13 patients went into remission with a median daily dose of ≤ 5mg prednisolone (equivalent), whereas 20 patients only required a median dose of 2.5 mg. Four patients were able to fully discontinue prednisolone treatment. Almost 50% of the patients claimed their QoL improved on TCZ. Overall, the US halo thickness decreased in 23 of arterial segments evaluated. The median Temporal Artery Halo Score decreased from 11 to 0. The median Axillary Artery Halo Score remains 6. The median Total Vascular Score on FDG-PET/CT showed a reduction of 11.5 to 6.5.

Conclusion: In our real-life clinical experience, TCZ showed an excellent response with acceptable safety in GCA. TCZ treatment was also associated with improvement on US and FDG-PET/CT imaging.

Disclosure: A. Sebastian, None; A. Kayani, None; D. Prieto-Peña, None; A. Tomelleri, None; M. Whitlock, None; K. van der Geest, Roche, 8; B. Dasgupta, Roche Chugai, 2, 5, 8, Sanofi, 2, 5, Abbvie, 2.

To cite this abstract in AMA style:

Sebastian A, Kayani A, Prieto-Peña D, Tomelleri A, Whitlock M, van der Geest K, Dasgupta B. Efficacy & Safety of Tocilizumab in Giant Cell Arteritis: A Single Centre NHS Experience Using Imaging (Ultrasound and PET CT) as a Diagnostic and Monitoring Tool [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/efficacy-safety-of-tocilizumab-in-giant-cell-arteritis-a-single-centre-nhs-experience-using-imaging-ultrasound-and-pet-ct-as-a-diagnostic-and-monitoring-tool/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-safety-of-tocilizumab-in-giant-cell-arteritis-a-single-centre-nhs-experience-using-imaging-ultrasound-and-pet-ct-as-a-diagnostic-and-monitoring-tool/