Giant Cell Arteritis in Treatment with Tocilizumab. Evolution of Vascular FDG Uptake on PET/CT

Diana Prieto Peña¹, Javier Loricera², Monica Calderón Goercke¹, Francisco Javier Narváez³, Elena Aurrecoechea⁴, Ignacio Villa-Blanco⁵, Santos Castañeda⁶, Catalina Gómez-Arango⁷, Noelia Álvarez-Rivas⁸, Antonio Mera⁹, Eva Perez Pampín⁹, Vicente Aldasoro¹⁰, Nagore Fernandez-Llanio Cornella¹¹, Maria Concepcion Alvarez de Buergo¹², Luisa Marena Rojas Vargas¹³, Francisca Sivera¹⁴, Eva Galindez-Agirregoikoa¹⁵, Roser Solans¹⁶, Susana Romero-Yuste¹⁷, Belén Atienza-Mateo¹⁸, José Luis Martín-Varillas¹⁸, Isabel Martínez-Rodríguez¹⁹, Ignacio Banzo¹⁹, Vanesa Calvo-Río¹⁸, Natalia Palmou-Fontana¹⁸, José Luis Hernández², Miguel Angel González-Gay¹⁸ and Ricardo Blanco¹⁸, ¹Rheumatology, Rheumatology. Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ²Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ³Rheumatology, Hospital Universitario de Bellvitge. Barcelona. Spain, Barcelona, Spain, ⁴Rheumatology, Hospital de Sierrallana. Torrelavega. Spain, Torrelavega, Spain, ⁵Hospital de Sierrallana. Torrelavega. Spain, Torrelavega, Spain, ⁶Rheumatology, Rheumatology Department, Hospital Universitario la Princesa, IIS-Princesa, Madrid, Spain, ⁷Hospital Alto Deba, Mondragón. Spain, Mondragón, Spain, ⁸Hospital Universitario Lucus Augusti, Lugo. Spain, Lugo, Spain, ⁹Rheumatology Division. Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain, ¹⁰Hospital Alto Deba. Mondragón. Spain, Mondragon, Spain, ¹¹Rheumatology Section. Hospital Arnau de Vilanova, Valencia, Spain, ¹²Rheumatology, Hospital Río Carrión. Palencia. Spain, Palencia, Spain, ¹³Rheumatology Department, Hospital General La Mancha Centro, Alcázar de San Juan, Spain, ¹⁴Rheumatology, Hospital General Universitario de Elda. Comunidad Valenciana. Spain, Elda, Spain, ¹⁵Rheumatology Division, Hospital Universitario de Basurto, Bilbao, Spain, ¹⁶Autoimmune Systemic Diseases Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Autonomous University of Barcelona, Spain, Barcelona, Spain, ¹⁷Hospital de Pontevedra. Spain, Pontevedra, Spain, ¹⁸Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ¹⁹Nuclear Medicine, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: giant cell arteritis, imaging techniques and tocilizumab

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: Giant cell arteritis (GCA) is a large-vessel vasculitis which can involve the aorta and/or its major branches. Tocilizumab (TCZ) seems to be effective in giant cell arteritis (GCA) (1-4). Our aim was to assess if the clinical and analytical improvement yielded in patients with GCA treated with TCZ is accompanied by a reduction of the vascular inflammation evaluated by PET/CT.

Methods: Study of 36 patients who had a baseline and follow-up PET/CT from a multicenter series of 134 patients with GCA in treatment with TCZ. The evolution of the vascular involvement objectified by PET/CT was assessed. In addition, clinical efficacy, analytical improvement (acute phase reactants) and the reduction of corticosteroid dose was studied.

Results: The 36 patients (28 women and 8 men) had a mean age of 69.8±8.6 years. After TCZ onset, a rapid and maintained clinical improvement was observed (TABLE). In addition, during the first twenty-four months of follow-up, C-reactive protein decreased from 2.4 [0.9-6.8] to 0.1 [0.0-0.5] mg / dL and the erythrocyte sedimentation rate from 41.5 [16.7-58.5] to 4 [2-12.5] mm/1st hour. On the other hand, the levels of haemoglobin experienced an increase from 12.3 [11.3-13.0] to 13.3 [13.0-13.9] g/dL. The median dose of prednisone decreased from 12.5 [9.4-26.2] to 0.0 [0.0-0.0] mg/day. However, the decrease in F18-fluordeoxyglucose uptake in the PET/CT study was not as evident, reaching a complete improvement in PET/CT uptake in 7 (20%) patients at 24 months of follow-up.

Conclusion: Although TCZ seems to be an important therapeutic agent in the treatment of GCA, achieving a rapid and sustained clinical and analytical improvement, the decrease in vessel inflammation assessed by F18-fluordeoxyglucose uptake seems to take a slower course.

	Baseline	Month 6	Month 12	Month 18	Month 24
Clinical improvement n, (%) Complete Partial No improvement		28/35 (80) 5/35 (14.3) 2/35 (5.7)	24/27 (88.9) 3/27 (11.1) 0 (0)	21/22 (95.4) 1/22 (4.5) 0 (0)	17/18 (94.4) 1/18 (5.5) 0 (0)
Laboratory markers, median [IQR]
ESR	41.5 [16.7-58.5] (36)	4 [2-8] (35)	4.5 [2-12] (28)	5 [2.5-11] (23)	4 [2-12.5] (19)
CRP	2.4 [0.9-6.8] (36)	0.1 [0.0-0.7] (33)	0.3 [0.1-0.6] (27)	0.1 [0.1-0.5] (23)	0.1 [0.0-0.5] (18)
Dose of corticosteroids (mg/day), median [IQR]	12.5 [9.4-26.2] (36)	5 [1.2-5.0] (33)	0.0 [0.0-2] (28)	0.0 [0.0-2.5] (21)	0.0 [0.0-0.0] (19)
Improvement in PET/CT Complete Partial No improvement		0/8 (0) 6/8 (75) 2/8 (25)	3/21 (14.3) 12/21 (54.3) 6/21 (28.6)	6/32 (18.75) 19/32 (59.4) 7/32 (21.9)	7/36 (19.4) 21/36 (58.3) 8/36 (22.2)

Disclosure: D. Prieto Peña, None; J. Loricera, None; M. Calderón Goercke, None; F. J. Narváez, None; E. Aurrecoechea, None; I. Villa-Blanco, None; S. Castañeda, None; C. Gómez-Arango, None; N. Álvarez-Rivas, None; A. Mera, None; E. Perez Pampín, None; V. Aldasoro, None; N. Fernandez-Llanio Cornella, None; M. C. Alvarez de Buergo, None; L. M. Rojas Vargas, None; F. Sivera, None; E. Galindez-Agirregoikoa, None; R. Solans, None; S. Romero-Yuste, None; B. Atienza-Mateo, None; J. L. Martín-Varillas, None; I. Martínez-Rodríguez, None; I. Banzo, None; V. Calvo-Río, None; N. Palmou-Fontana, None; J. L. Hernández, None; M. A. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Prieto Peña D, Loricera J, Calderón Goercke M, Narváez FJ, Aurrecoechea E, Villa-Blanco I, Castañeda S, Gómez-Arango C, Álvarez-Rivas N, Mera A, Perez Pampín E, Aldasoro V, Fernandez-Llanio Cornella N, Alvarez de Buergo MC, Rojas Vargas LM, Sivera F, Galindez-Agirregoikoa E, Solans R, Romero-Yuste S, Atienza-Mateo B, Martín-Varillas JL, Martínez-Rodríguez I, Banzo I, Calvo-Río V, Palmou-Fontana N, Hernández JL, González-Gay MA, Blanco R. Giant Cell Arteritis in Treatment with Tocilizumab. Evolution of Vascular FDG Uptake on PET/CT [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/giant-cell-arteritis-in-treatment-with-tocilizumab-evolution-of-vascular-fdg-uptake-on-pet-ct/. Accessed .

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