FRI0357 Assessment of patients with takayasu’s arteritis in a routine clinical follow-up with indian takayasu clinical activity score (itas2010)

Abstract

Patients.– Case notes from ninety-eight patients with Takayasu arteritis were reviewed retrospectively. Drug treatment, laboratory and imaging data were analysed, and disease activity further assessed using the Indian Takayasu arteritis (ITAS) and damage scores (TADs). Results.– Nine patients were treated with biologics, all had previously received high dose prednisolone and ! 1 immunosuppressant drug, and five patients had failed cyclophosphamide. Three patients re-ceived more than one agent and eight remain on biologics. The patients prescribed biologics had more extensive arterial disease than the rest of the cohort (5–9 arteries involved, TADs 3-11), with active disease prior to the initiation of biologics (ITAS 2–9 and CRP 12– 206 mg/L). The mean duration of treatment was 2.6 years, and one patient suffered a significant adverse event. Eight patients were prescribed anti-TNFa therapy, three anti-IL-6R blockade. One patient developed new arterial stenoses while receiving anti-TNFa and sub-sequently responded to tocilizumab. Two patients received the IL-6R antagonist as a first-line biologic. Biologic therapy resulted in a significant fall in CRP (P < 0.01) and prednisolone dose (P < 0.01). Likewise, ITAS fell from 4.1 to 1.4 (P < 0.01), and no significant progression in arterial injury was observed, either by non-invasive imaging or TADs. Discussion.– Although anti-TNFa therapy is effective in refractory Ta-kayasu's, upto 30% do not respond or relapse. While tocilizumab offers an alternative in these cases, suppression of constitutional symptoms and CRP complicates disease monitoring, and regular imaging is required. Conclusion.– In refractory Takayasu arteritis, TNFa and IL6R blockade proved an effective option. In light of their efficacy in cyclophospha-mide non-responders, we propose to use biologics ahead of cyclopho-sphamide in these young patients. Introduction.– ITAS2010 is a new composite index developed to assess clinical activity in Takayasu's arteritis (TAK), which is weighted for vascular items. We aimed to investigate the effectiveness of ITAS2010 in the routine clinical follow-up of TAK. Patients.– Patients (n = 33, mean age: 40.9 AE 12 years, F/M: 30/3) classified according to ACR criteria for TAK were enrolled. ITAS2010 forms were filled cross-sectionally for baseline, two follow-up visits prospectively, with intervals of at least 4–6 months, by including only new or worsening symptoms within the past 3 months. Results.– ITAS2010 was similar at baseline for both active and inactive patient [12 (5–20) vs.10 (0–19), respectively]. There was no correlation between ITAS2010 and acute phase reactants (APRs). Similarly, change according to PGA was not reflected in ITAS in the second visit [1.15 (0–6) vs.1.4 (0–3), respectively]. Only three visit ITAS2010 score was ob-served to be significantly higher in active [1,62 (0–7)] patients com-pared to inactives [0.45 (0–3)] (P = 0.001). The total agreement between ITAS2010 and PGA was 60% (kappa: 0.096, P = 0.43) and between ITAS2010 and Kerr et al. [1] was 74% (kappa: 0.18, P = 0.035). The total agreement between PGA and Kerr et al. was 71% (kappa: 0.26, P = 0.005). Twelve patients were evaluated with imaging in the follow-up (four with PET, eight with MR-Angiography). When we added an extra-score on ITAS2010 for high APRs or positive imaging (vascular progression with radiology or increased uptake on vascular structures with PET), the total agreement between ITAS2010 and PGA increased to 74% (kappa: 0.499, P < 0.001), whereas ITAS2010 and Kerr et al. decreased to 51% (kappa: 0.102, P = 0.06). Conclusion.– The agreement between PGA and ITAS2010 was observed to be limited. However, when we combined ITAS2010 with APR or imaging, our results improved. ITAS2010 had a significant discri-minatory value according to disease activity in only the third visit in our routine follow-up. These results suggest that ITAS2010 may be valu-able in the long-term follow-up, especially if combined with biomar-kers and imaging.