Quantitative ultrasound to monitor the vascular response to tocilizumab in giant cell arteritis.

Seitz, Luca; Christ, Lisa; Lötscher, Fabian; Scholz, Godehard; Sarbu, Adela-Cristina; Bütikofer, Lukas; Kollert, Florian; Schmidt, Wolfgang A; Reichenbach, Stephan; Villiger, Peter M. (2021). Quantitative ultrasound to monitor the vascular response to tocilizumab in giant cell arteritis. (In Press). Rheumatology Oxford University Press 10.1093/rheumatology/keab484

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OBJECTIVES

To characterize the effect of ultra-short glucocorticoids followed by Tocilizumab monotherapy on the intima-media thickness (IMT) in GCA.

METHODS

18 GCA patients received 500mg methylprednisolone intravenously on days 0-2, followed by Tocilizumab (8mg/kg) intravenously on day 3 and thereafter weekly subcutaneous Tocilizumab injections (162 mg) over 52 weeks. Ultrasound of temporal (TA), axillary (AA) and subclavian (SA) arteries was performed at baseline, on days 2-3, at week 4, 8, 12, 24 and 52. The largest IMT of all segments and IMT at landmarks of AA/SA were recorded. IMT was scaled by mean normal values and averaged. Each segment was classified according to diagnostic cut-offs.

RESULTS

16 patients had TA and 6 had extracranial large artery involvement. The IMT showed a sharp decline on day 2/3 in the TA and AA/SA. In TA, this was followed by an increase to baseline levels at week 4 and a subsequent slow decrease, which was paralleled by decreasing symptoms and achievement of clinical remission. The AA/SA showed a new signal of vasculitis at week 4 in three patients with an IMT increase up to week 8.

CONCLUSIONS

Glucocorticoid pulse therapy induced a transient decrease of the IMT in TA and AA/SA. Tocilizumab monotherapy resulted in a slow and steady decrease in IMT of the TA and a smaller and delayed effect on the AA/SA. The data strongly support a remission-inducing effect of Tocilizumab and argue for an important role of ultrasound in monitoring disease activity in GCA.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Rheumatology, Clinical Immunology and Allergology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Seitz, Luca; Christ, Lisa Alexandra; Lötscher, Fabian; Scholz, Godehard Albert; Sarbu, Adela-Cristina; Bütikofer, Lukas; Kollert, Florian Kim; Reichenbach, Stephan and Villiger, Peter

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1462-0324

Publisher:

Oxford University Press

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

16 Jun 2021 10:06

Last Modified:

16 Jun 2021 10:06

Publisher DOI:

10.1093/rheumatology/keab484

PubMed ID:

34117737

Uncontrolled Keywords:

Giant cell arteritis glucocorticoids tocilizumab ultrasound vascular response vasculitis

BORIS DOI:

10.48350/156887

URI:

https://boris.unibe.ch/id/eprint/156887

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