Date: Monday, November 9, 2015
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: To evaluate the interest of 18F-FDG positron emission tomography-computed tomography (PET-CT) for therapeutic assessment in polymyalgia rheumatica (PMR) patients undergoing tocilizumab (TCZ) therapy at first line.
Patients were prospectively enrolled in a twenty four weeks open label longitudinal, prospective multicenter study assessing TCZ therapy on PMR patients (TENOR: Tolerance and Efficacy of tocilizumab iN pOlymyalgia Rheumatica). They underwent 18F-FDG positron emission tomography-computed tomography (PET-CT) at baseline, after the first infusion of TCZ (TCZ 1) and after the last infusion of TCZ (TCZ 3). PMR activity score (PMR-AS), C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) lab tests were also assessed. Maximal standardized uptake value (SUVmax) was used for assessment of FDG uptake regions usually seen in PMR (spinous processes, hips, shoulders, sternoclavicular and ischial tuberosities). Wilcoxon test was applied to evaluate parameter’s changes after infusions and Spearman’s rank correlation test was applied to assess the correlation between SUVmax and PMR-AS, CRP and ESR.
Results: Eighteen patients were included. On baseline PET-CT, abnormal joint uptakes (upper than the liver background) were found most frequently in ischial tuberosities and hips regions (94% of patients) following by shoulders region (89%). Cervical spinous processes were the less frequently described (56% of patients). Bioclinical parameters decreased after TCZ 1 (PMR-AS: from 37 to 18, CRP: from 82 to 1 and ESR from 56 to 4, all p<0.05) as well as SUVmax (SUVmax: from 5.9 to 5.4, p<0.05). All parameters decreased also after TCZ 3 (PMR-AS from 37 to 4, CRP from 82 to 1 and ESR from 56 to 4; SUVmax from 5.9 to 4.6; p<0.05). On region based analysis, all SUVmax were significantly reduced after TCZ 3, except for cervical spinous processes and shoulders regions. Concerning correlations, DSUVmax on patient based analysis was significantly correlated with DPMR-AS after TCZ 1 (r=0.5, p=0.04) such as left hip DSUVmax with DCRP after TCZ 1 (r=0.64, p=0.01).
Conclusion: FDG PET-CT uptake decreased significantly after TCZ therapy in PMR patients and might reflect disease activity.
To cite this abstract in AMA style:Palard X, Querellou S, Gouillou M, Saraux A, Marhadour T, Garrigues F, Abgral R, Salaun PY, Devauchelle V. Value of 18F-FDG PET for Therapeutic Assessment in Patients with Polymyalgia Rheumatica Treated in First Line By Tocilizumab [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/value-of-18f-fdg-pet-for-therapeutic-assessment-in-patients-with-polymyalgia-rheumatica-treated-in-first-line-by-tocilizumab/. Accessed October 25, 2021.
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