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POS0730 PROGNOSTIC FACTORS AND EFFICACY OF DMARD USE IN GCA: RESULTS FROM THE PROSPECTIVE, LONGITUDINAL,MULTI-CENTRE HAS-GCA STUDY
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  1. B. Dasgupta1,2,
  2. K. Van der Geest3,
  3. A. Tomelleri4,
  4. P. Macchioni5,
  5. G. Klinowski5,6,
  6. C. Salvarani5,6,
  7. A. Kayani1,
  8. M. Tariq1,
  9. D. Prieto-Peña7,
  10. E. Conticini8,
  11. M. Khurshid9,
  12. S. Inness2,
  13. J. Jackson2,
  14. A. Sebastian1,2,10
  1. 1Southend University Hospital, Mid and South Essex NHS Foundation Trust, Rheumatology, Southend-on-Sea, United Kingdom
  2. 2University of Essex Colchester Campus, Sports,Rhehabilitation, and Excercise, Colchester, United Kingdom
  3. 3University Medical Center Groningen, Rheumatology and Clinical Immunology, Groningen, Netherlands
  4. 4San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Milano, Italy
  5. 5Azienda USL - IRCCS - di Reggio Emilia- Area Territoriale Veterinaria di Castelnovo ne’Monti, Rheumatology, Castelnovo ne’ Monti, Italy
  6. 6University of Modena and Reggio Emilia, Rheumatology, Modena, Italy
  7. 7Marqués de Valdecilla University Hospital, Rheumatology, Santander, Spain
  8. 8University of Siena, Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Siena, Italy
  9. 9University Hospital Dorset, NHS foundation trust, Rheumatology, Dorset, United Kingdom
  10. 10University Hospital Limerick, Rheumatology, Limerick, Ireland

Abstract

Background GCA is a critically ischemic large vessel vasculitis, varying in extent, severity and outcomes, hence requires disease stratification using clinical, laboratory and imaging parameters, for targeted management. Although DMARDs are used, the effectiveness in real life, such adjuvants remain un-elucidated. We performed a prospective, multi centre cohort study of new GCA stratified into remitting, relapsing, refractory, ischemic disease.

Objectives We assessed prognostic factors and compared critical outcomes such as remission with glucocorticoid (GC) monotherapy versus GC plus DMARDs in the first 12 months.

Methods HAS GCA study (1) recruited consecutive patients with new onset GCA from 7 centres (UK, Italy, Spain, Netherlands). diagnosis was confirmed used a modified GiACTA criteria at 6 months follow up. All underwent ultrasound (bilateral common, parietal, frontal temporal arteries, and axillary arteries) using accepted standard cut-off values [2]. GCA patients had US at baseline,1,3,6,12 months and halo count (HC) and Halo score (Temporal TAHS, axillary AAHS, total THS) assessed [3]. The primary outcome- remission at 12 months (absence of signs/symptoms, CRP<5 mg/dl, prednisolone < 5 mg daily). Results are reported as descriptive statistics.

Results 229 participants included in the study (GCA- 84 (36.68 %) (Figure 1). Study recruited during Covid pandemic,73 completed,11 lost to follow-up (died -7, withdrawn-4). The deceased/withdrawn patients (compared to completers) were older (80 v74 yrs, p=0.018), preponderantly male (73% v 36%, p=0.043) with visual symptoms (91% v 49%, p=0.010) partial/total sight loss (55% v 21%, p=0.024), lower CRP (21 v 68, p=0.061) and ESR (42 v 62, p= 0.317).

Of 73 completers 36 required early DMARDs (<12 weeks) for refractory/relapsing/ischemic/GC related AEs. This group had more LV involvement (50% v 11%, p=0.0003), Remission attained at 12 months 32/36 (89%) in DMARD group was comparable to the remitting GC monotherapy group 33/37 (89%) with comparable cumulative GC doses (Figure 1, Table 1).

At 12-months follow up, median TAHS, AAHS and THS reduced from 13 to 3, 12 to 9 and 21.5 to 12, respectively.

Conclusion Our study suggests, elderly males with visual symptoms, sight loss, lower CRP are a high-risk group with increased mortality within GCA. Difficult to treat disease is seen in half of all patients especially with LV involvement. This group responds well to early DMARD use achieving remission comparable to the remitting group at 12 months. Current therapies fail to achieve remission in 9.5 % of cases. HS and HC show significant improvement mirroring clinical outcomes during first 12 months of therapy.

References [1]Sebastian A et al. BMC Rheum. 2020

[2]Schafer VS et al. Rheumatology 2017

[3]van der Geest KSM et al. ARD 2020

Table 1.

comparison between the DMARD-used group and only GC group in all the GCA completed the 12 months follow up

Acknowledgements: NIL.

Disclosure of Interests Bhaskar Dasgupta Consultant of: Roche, Chugai, Sanofi, Grant/research support from: Roche, Sanofi, AbbVie, and GlaxoSmithKline, Kornelis van der Geest Speakers bureau: Roche

, Grant/research support from: AbbVie, Alessandro Tomelleri: None declared, Pierluigi Macchioni: None declared, Giulia Klinowski: None declared, Carlo Salvarani: None declared, Abdul Kayani: None declared, Mohammad Tariq: None declared, Diana Prieto-Peña: None declared, Edoardo Conticini: None declared, Muhammad Khurshid: None declared, Sue Inness: None declared, Jo Jackson: None declared, Alwin Sebastian: None declared.

  • Vasculitis
  • Ultrasound
  • Imaging

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