Article
Quantification of tocilizumab (TCZ) response in patients with rheumatoid arthritis by indocyanine green (ICG) enhanced fluorescence optical imaging (FOI)
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Authors
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Peter Kästner
- MVZ Ambulantes Rheumazentrum Erfurt, Erfurt
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Michael Schirner
- Mivenion GmbH, Berlin
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Sara Kästner
- MVZ Ambulantes Rheumazentrum Erfurt, Erfurt
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Mathias Cziumplik
- Mivenion GmbH, Berlin
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Peter Hellmann
- Chugai Pharma Marketing Ltd., Frankfurt/Main
| Published: | September 1, 2015 |
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Outline
Text
Introduction: The diagnosis and treatment of rheumatoid arthritis (RA) at an early stage is highly influential on disease progression. Therefore, there is a need for objective and sensitive diagnostic tools. Fluorescence optical imaging (FOI) is a novel technology for the assessment of inflammation in all joints of the hand which needs clinical evaluation.
Methods: A thorough clinical examination as well as the FOI measurement (Xiralite, mivenion, Berlin, Germany; 0.1mg/kg of Indoxyanine green (ICG) over 6 minutes intravenously) was performed in 16 patients with active RA (DAS 28: 5.22 to 8.8) based on the ACR criteria before treatment with Tocilizumab (TCZ) and after 3 and 6 months of therapy. All patients received infusions of TCZ (8mg/kg) every 4 weeks. The activity of the inflammation was quantified by fluorescence optical imaging (measurement of high intensity areas of both hands, DACT) and by the application of the DAS 28 in patients.
Results: The mean DACT score changed significantly from 4.37 at baseline to 3.76 after 3 months and decreased further to 3.43 at the end of the study. This change correlated significantly to the clinical improvement indicated by the mean DAS 28 value at baseline of 6.74 which decreased to 3.45 after 3 months and to 3.29 after 6 months.
Conclusion: This cohort evaluation shows the clinical improvement of the activity of the RA after TCZ treatment which was accompanied by a significant reduction of DACT values obtained by the FOI measurement. This is the first study investigating the effects of biologic agents in active arthritis and our results suggest therefore that FOI can be used as a more objective assessment of disease activity being possibly suitable for the disease monitoring and treatment responses. However, to include all patient groups an additional scanner for ankle and toes needs to be introduced. The individual assessment of subclinical inflammatory activity in different joints might even allow the specific treatment of single joints by means of intraarticular glucocorticoid injections.
