Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.
Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.
Rheumatology (Oxford). 2021 Aug 2;60(8):3851-3861. doi: 10.1093/rheumatology/keab332.
Efficacy evaluation of GCA treatment is primarily based on non-specific symptoms and laboratory markers. We aimed to assess the change in vascular inflammation in patients with large vessel (LV)-GCA under different treatments using [18F]FDG PET/CT.
Observational study on patients with new-onset, active LV-GCA starting treatment with either prednisolone monotherapy (PRED) or combination with MTX or tocilizumab (TOC). All patients underwent baseline and follow-up PET/CT. The aorta and its major branches were assessed using PET vascular activity score (PETVAS) by independent readers. Cumulative glucocorticoid doses and cessation of glucocorticoid treatment were documented in all patients.
We included 88 LV-GCA patients, 27 were treated with PRED, 42 with MTX and 19 with TOC. PETVAS decreased from 18.9-8.0 units at follow-up in the overall population (P <0.001). PETVAS changes were numerically higher in patients receiving MTX (-12.3 units) or TOC (-11.7 units) compared with PRED (-8.7). Mean cumulative prednisolone dosages were 5637, 4418 and 2984 mg in patients treated with PRED, MTX and TOC (P =0.002). Risk ratios for glucocorticoid discontinuation at the time of follow-up PET/CT were 6.77 (95% CI: 1.01, 45.29; P =0.049) and 16.25 (95% CI: 2.60, 101.73; P =0.003) for MTX and TOC users compared with PRED users.
Treatment of LV-GCA inhibits vascular inflammation in the aorta and its major branches. While similar control of vascular inflammation was achieved with PRED, MTX and TOC treatments, TOC showed a strong glucocorticoid sparing effect, supporting the concept of initial combination therapy.
巨细胞动脉炎（GCA）治疗的疗效评估主要基于非特异性症状和实验室标志物。我们旨在使用 [18F]FDG PET/CT 评估不同治疗方案下大血管（LV）-GCA 患者的血管炎症变化。
对新诊断、活动期 LV-GCA 患者进行观察性研究，这些患者开始接受泼尼松单药治疗（PRED）或联合甲氨蝶呤（MTX）或托珠单抗（TOC）治疗。所有患者均接受基线和随访 PET/CT 检查。由独立的读者使用 PET 血管活性评分（PETVAS）评估主动脉及其主要分支。所有患者均记录累积糖皮质激素剂量和糖皮质激素治疗的停药情况。
共纳入 88 例 LV-GCA 患者，其中 27 例接受 PRED 治疗，42 例接受 MTX 治疗，19 例接受 TOC 治疗。总体人群的 PETVAS 从基线时的 18.9-8.0 单位下降（P<0.001）。与 PRED 组（-8.7 单位）相比，接受 MTX（-12.3 单位）或 TOC（-11.7 单位）治疗的患者的 PETVAS 变化数值更高。接受 PRED、MTX 和 TOC 治疗的患者的平均累积泼尼松剂量分别为 5637、4418 和 2984mg（P=0.002）。在随访 PET/CT 时，MTX 和 TOC 使用者的糖皮质激素停药风险比分别为 6.77（95%CI：1.01，45.29；P=0.049）和 16.25（95%CI：2.60，101.73；P=0.003），高于 PRED 使用者。
治疗 LV-GCA 可抑制主动脉及其主要分支的血管炎症。虽然 PRED、MTX 和 TOC 治疗方案均能达到相似的血管炎症控制效果，但 TOC 具有强烈的糖皮质激素节约作用，支持初始联合治疗的概念。
