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Abstract Number: 1921

Ongoing Vascular 18F-FDG Uptake Despite Clinical Remission in Patients Receiving Tocilizumab for Large Vessel Vasculitis-Giant Cell Arteritis: Single Universitary Center Experience of 30 Patients

Lara Sanchez-Bilbao1, Diana Prieto-Peña2, Inigo Gonzalez-Mazon3, David Martinez-Lopez4, Monica Calderon-Goercke5, Isabel Martínez-Rodríguez5, Ignacio Banzo5, Miguel Ángel González-Gay6 and Ricardo Blanco1, 1Hospital Universitario Marques de Valdecilla, Santander, Spain, 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, 3Hospital Universitario Marques de Valdecilla, Bezana, Spain, 4Hospital Universitario Marques de Valdecilla, Santander (SPAIN), Spain, 5Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain, 6Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain

Meeting: ACR Convergence 2020

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Session Information

Date: Monday, November 9, 2020

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

Session Type: Poster Session D

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

Background/Purpose: Tocilizumab (TCZ) has shown efficacy in large vessel vasculitis (LVV)-giant cell arteritis (LVV-GCA). Disease activity in LVV assessed by laboratory parameters (ESR, CRP) may be of less value with TCZ. Imaging assessment by 18F-fluodeoxyglucose positron emission tomography (18F-FDG PET/CT) may be useful to monitor LVV disease activity.

Our aim was to determine if clinical improvement correlated with decrease of vascular uptake in follow-up PET/CT scans.

Methods: Single center study of patients with refractory LVV-GCA treated with TCZ who had a baseline and follow-up PET/CT scan. For the visual analysis, FDG uptake at the thoracic aorta wall was visually grading compared to the liver uptake (0: no uptake, 1: less than liver, 2: equal to liver, 3: uptake greater than liver uptake). We defined a total vascular score (TVS) which included 5 vascular regions (supra aortic trunks, thoracic aorta, abdominal aorta, iliac arteries, femorotibial arteries) ranging from 0 to 15. Besides, a semiquantitative analysis was performed as a target to background ratio (TBR)= SUVmax thoracic aorta wall/SUVmax aortic vascular pool. The baseline and follow-up TVS and TBR were compared. Clinical and analytical improvement and and reduction of prednisone dose (mg/day) were also assessed.  

Results: We included 30 patients (24 women/6 men); mean age 65.7± 9.8 years. Baseline PET/CT scans were performed due to active disease at a median [interquartile range-IQR] of 1.5 [0.0-4.0] months before TCZ onset. Following TCZ therapy, 25 (83.33%) patients achieved clinical remission and reduction of FDG vascular uptake was also observed after a mean of 10.8±3.7 months. TBR decreased from 1.70 ± 0.52 to 1.48 ± 0.25 (p=0.005) and TVS from 4.97±2.62 to 3.13±1.89 (p< 0.001). However, only 9 (30%) patients showed complete normalization of TBR and only 3 (10%) normalization of TVS (TABLE).

Conclusion: Most of patients with LVV under TCZ therapy experienced a rapid and effective clinical and analytical improvement. However, less than one-third show normalization of 18F-FDG vascular uptake.


Disclosure: L. Sanchez-Bilbao, None; D. Prieto-Peña, None; I. Gonzalez-Mazon, None; D. Martinez-Lopez, Lilly, 2; M. Calderon-Goercke, None; I. Martínez-Rodríguez, None; I. Banzo, None; M. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Sanchez-Bilbao L, Prieto-Peña D, Gonzalez-Mazon I, Martinez-Lopez D, Calderon-Goercke M, Martínez-Rodríguez I, Banzo I, González-Gay M, Blanco R. Ongoing Vascular 18F-FDG Uptake Despite Clinical Remission in Patients Receiving Tocilizumab for Large Vessel Vasculitis-Giant Cell Arteritis: Single Universitary Center Experience of 30 Patients [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/ongoing-vascular-18f-fdg-uptake-despite-clinical-remission-in-patients-receiving-tocilizumab-for-large-vessel-vasculitis-giant-cell-arteritis-single-universitary-center-experience-of-30-patients/. Accessed May 17, 2022.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ongoing-vascular-18f-fdg-uptake-despite-clinical-remission-in-patients-receiving-tocilizumab-for-large-vessel-vasculitis-giant-cell-arteritis-single-universitary-center-experience-of-30-patients/

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