Temporal ultrasound for monitoring tocilizumab treatment in giant cell arteritis: seeing beyond serum markers?

Evangelatos, Gerasimos; Fragoulis, G.; Iliopoulos, Alexios

doi:10.1136/annrheumdis-2019-216527

Cited by 6 publications

(2 citation statements)

References 7 publications

(8 reference statements)

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“…Advanced imaging modalities have an increasing role in disease monitoring in GCA and might be particularly helpful for patients on TCZ when other markers are not available. Several cases of temporal artery ultrasound showing disappearance of the halo sign after initiation of TCZ have been reported [31,32]. In patients with LV-GCA, monitoring with serial computed tomography angiography (CTA) or magnetic resonance angiography (MRA) is recommended [22 ▪▪ ,23].…”

Section: How Should We Monitor Disease Activity On Tocilizumab?mentioning

confidence: 99%

Tocilizumab in giant cell arteritis: an update for the clinician

Ford

Gewurz

Gewurz‐Singer

2023

Current Opinion in Rheumatology

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Purpose of reviewThe recent approval of tocilizumab (TCZ) for the treatment of giant cell arteritis (GCA) has changed the landscape for management of this disease. Herein, we review recent literature addressing practical questions for the clinician regarding the use of TCZ in GCA. We evaluate efficacy of TCZ across different disease phenotypes, optimal dosing and formulation, treatment-related toxicity, recommendations for monitoring disease, and duration of therapy.Recent findingsPost-hoc analyses of a large clinical trial and real-world data suggest efficacy of TCZ across various disease phenotypes in GCA, and support use of weekly subcutaneous dosing over every-other-week dosing. More data are needed to guide duration of TCZ therapy, optimal disease activity monitoring in patients treated with TCZ, and to speak to efficacy in GCA with large vessel involvement.SummaryTCZ has added valuably to the treatment arsenal in GCA, though more data are needed to guide optimal use of the drug.

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Section: How Should We Monitor Disease Activity On Tocilizumab?mentioning

confidence: 99%

Tocilizumab in giant cell arteritis: an update for the clinician

Ford

Gewurz

Gewurz‐Singer

2023

Current Opinion in Rheumatology

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“…Similarly with PET/CT, the majority of patients still have some degree of vascular uptake after 1 year, though the level of maximal uptake can potentially help to distinguish patients in remission from those with active disease [11▪,30]. For temporal artery ultrasound, one group described two patients in whom the halo sign was significantly diminished with tocilizumab treatment, and further studies are ongoing to evaluate this [31]. The use of imaging to confirm or exclude a flare is not known though is recommended for long-term monitoring of patients with known large vessel involvement [1▪▪].…”

Section: Monitoring With Serial Imagingmentioning

confidence: 99%

Recent advances in the diagnosis and management of giant cell arteritis

Serling‐Boyd

Stone

2020

Current Opinion in Rheumatology

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Purpose of review-Giant cell arteritis (GCA) has classically been diagnosed by temporal artery biopsy and treated with high-dose, long-term glucocorticoid therapy. Noninvasive imaging increasingly is employed for diagnostic purposes, but further studies are needed to determine the role of imaging in monitoring longitudinal disease activity. Glucocorticoid-sparing therapy mitigates the numerous adverse effects of glucocorticoids. This review addresses new developments in these areas. Recent findings-For diagnosis, when performed at a center with expertise in its use, temporal artery ultrasound has an estimated sensitivity and specificity of 78 and 79%, respectively. State-ofthe-art time-of-flight positron emission tomography/computed tomography (PET/CT) has an estimated sensitivity and specificity of 71 and 91%, respectively. The sensitivities of both imaging modalities decrease following glucocorticoid administration. Tocilizumab is an effective glucocorticoid-sparing therapy, demonstrating sustained glucocorticoid-free remission in 56% of patients receiving weekly tocilizumab compared with 18% of patients receiving a 52-week prednisone taper. The traditional acute phase reactants are of no value in patients treated with interleukin-6 receptor (IL6-R) blockade, and thus, the development of new biomarkers is an important priority in the field. Summary-Noninvasive imaging techniques are increasingly used in the absence of temporal artery biopsy to confirm diagnostic suspicions of GCA. Tocilizumab reduces the cumulative glucocorticoid exposure and increases the rate of sustained remission. Ongoing efforts are directed towards new methods to identify disease flares.

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