- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03765424
Evaluation of Ultrasound and PET/CT in the Diagnosis and Monitoring of Giant Cell Arteritis
The aim of this project is to prospectively evaluate the diagnostic accuracy of different imaging tools in specific giant cell arteritis disease subsets before and after treatment initiation. Diagnostic tools with high sensitivity and specificity are a prerequisite for optimal treatment of GCA patients.
Specifically, the diagnostic accuracy of ultrasound (US) as compared to 18F-FDG PET/CT in new-onset, treatment naïve large vessel(LV)-GCA patients is investigated. Furthermore, long-term follow up including US, 18F-FDG PET/CT and cross sectional imaging is performed to explore the potential of imaging as monitoring and prognostic tools.
In this observational cohort, the diagnostic accuracy of 18F-FDG PET/CT after three and ten days of glucocorticoid treatment in the subset of LV-GCA patients and the diagnostic accuracy of 18F-FDG PET/CT in cranial artery inflammation in new-onset, treatment naïve c-GCA patients as compared to a control group of patients with a previous diagnosis of malignant melanoma was also evaluated and is registered elsewhere (ClinicalTrials.gov Identifier: NCT03285945 and NCT03409913, respectively)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The diagnosis of GCA is clinical and syndrome-based. Only few years ago, temporal artery biopsy (TAB) was the standard diagnostic tool to confirm diagnosis, although sensitivity is moderate[3,4] and its outcome seldom affects treatment management[5]. Today, the European League Against Rheumatism (EULAR) recommends diagnostic imaging in all patients suspected of GCA[6]. The imaging of choice is based on the suspected vessel involvement. In patients suspected of cranial GCA (c-GCA), vascular ultrasound (US) is the recommended first line imaging test, whereas Fluorine-18-fluorodeoxyglucose (18F-FDG) positron emissions tomography/computed tomography (PET/CT) is not recommended for the assessment of cranial arteries.
In patients suspected of large vessel involvement (LV-GCA), 18F-FDG PET/CT, US, magnetic resonance imaging (MRI) or CT can be used to confirm disease, but no specific priority of the imaging tests is given. US is an attractive first line imaging in LV-GCA suspected patients since it is increasingly used in the diagnosis of c-GCA, is readily available and cheap. 18F-FDG PET/CT is an appealing diagnostic tool in LV-GCA suspected patients, since it also evaluates malignancy and infection, differential diagnoses often considered in this disease subset. However, 18F-FDG PET/CT is often not readily available, is expensive and exposes patients to radiation. Moreover, its sensitivity seems to decrease with glucocorticoid (GC) treatment and the window of opportunity in which sensitivity is unaffected is unknown.
Relapse during glucocorticoid tapering is frequent in GCA. However, the evaluation of potential GCA disease activity relies on unspecific symptoms and inflammatory biomarkers. There is a significant overlap between symptoms of GCA disease activity and GC adverse effect and the same holds for symptoms and biomarkers of disease activity and infection, making the evaluation difficult. Accurate tools to support treatment decisions, avoid over-treatment without risk of GCA related complications are lacking.
The aim of this project is to prospectively evaluate the diagnostic accuracy of different imaging tools in specific giant cell arteritis disease subsets before and after treatment initiation. Diagnostic tools with high sensitivity and specificity are a prerequisite for optimal treatment of GCA patients.
Specifically, the diagnostic accuracy of ultrasound (US) as compared to 18F-FDG PET/CT in new-onset, treatment naïve large vessel(LV)-GCA patients is investigated. Furthermore, long-term follow up including US, 18F-FDG PET/CT and cross sectional imaging is performed to explore the potential of imaging as monitoring and prognostic tools.
In this observational cohort, the diagnostic accuracy of 18F-FDG PET/CT after three and ten days of glucocorticoid treatment in the subset of LV-GCA patients and the diagnostic accuracy of 18F-FDG PET/CT in cranial artery inflammation in new-onset, treatment naïve c-GCA patients as compared to a control group of patients with a previous diagnosis of malignant melanoma was also evaluated and is registered elsewhere (ClinicalTrials.gov Identifier: NCT03285945 and NCT03409913, respectively)
Study Type
Enrollment (Actual)
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Age more than 50 years
- C-reactive protein (CRP)>15 mg/L or erythrocyte sedimentation rate (ESR)>40 mm/h
Either
- cranial symptoms such as new-onset headache or scalp tenderness, jaw or tongue claudication, visual disturbances
- new-onset limb claudication
- protracted constitutional symptoms, defined as weight loss>5 kilograms or fever>38 degrees Celcius for >3 weeks
- Bilateral shoulder pain and morning stiffness.
Exclusion Criteria:
- oral glucocorticoid treatment within the past month;
- subcutaneous, intramuscular, intra-articular or intravenous glucocorticoid within the past 2 months;
- DMARD treatment or other immunosuppressive therapy within the past 3 months;
- ongoing treatment with interleukin2;
- previous diagnosis of GCA or polymyalgia rheumatica;
- any disease potentially causing large vessel inflammation, that is autoimmune diseases; rheumatoid arthritis, Cogans syndrome, relapsing polychondritis, ankylosing spondylitis, systemic lupus erythematosus, Buerger's disease, Bechet's disease, inflammatory bowel disease, infections; syphilis, known active current or history of recurrent tuberculosis, hepatitis or HIV, or other large vessel disease; sarcoidosis, neurofibromatosis, congenital coarctation, Marfans syndrome, Ehlers-Danlos syndrome, retroperitoneal fibrosis.
Study Plan
How is the study designed?
Design Details
- Observational Models: Cohort
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
GCA cases
GCA cases were patients with a clinical diagnosis of GCA based on a rheumatologists evaluation of history taking, physical examination, laboratory screening and initial PET report (reporting potential large vessel inflammation but not considering cranial artery inflammation). GCA was considered large vessel (LV) and/or cranial (c) GCA cases: LV-GCA cases were patients with a clinical diagnosis of GCA and verified LV inflammation by 18F-FDG PET/CT with or without concomitant c-GCA. C-GCA cases, for the exploratory analysis of the performance of US and PET in c-GCA, were patients with a clinical diagnosis of GCA fulfilling the 1990 American College of Rheumatology (ACR) criteria, with or without concomitant LV-GCA. |
Ultraosund of temporal, carotid and axillary arteries
|
controls
Controls were GCA suspected patients in whom GCA diagnosis was dismissed.
|
Ultraosund of temporal, carotid and axillary arteries
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Diagnostic accuracy of large vessel ultrasound with PET/CT as reference
Time Frame: Time of diagnosis/pre-treatment
|
Large vessel ultrasound for LV-GCA diagnosis is considered positive in the presence of a halo in carotid and/or axillary arteries.
|
Time of diagnosis/pre-treatment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Large vessel intima-media thickness (IMT) cut off for LV-GCA diagnosis with PET/CT as reference
Time Frame: Time of diagnosis/pre-treatment
|
IMT measurement performed on the distal vessel wall in carotid and axillary arteries
|
Time of diagnosis/pre-treatment
|
Diagnostic accuracy vascular ultrasound (overall)
Time Frame: Time of diagnosis/pre-treatment
|
Vascular ultrasound for GCA diagnosis is considered positive in the presence of a halo in temporal, carotid and/or axillary arteries.
|
Time of diagnosis/pre-treatment
|
Diagnostic accuracy of vascular ultrasound after treatment (day 3, 10 and week 8)
Time Frame: 3 days, 10 days and 8 weeks after initiated treatment
|
Vascular ultrasound for GCA diagnosis is considered positive in the presence of a halo in temporal, carotid and/or axillary arteries.
|
3 days, 10 days and 8 weeks after initiated treatment
|
Diagnostic accuracy of PET/CT of cranial arteries for c-GCA diagnosis (reference: American College of Rheumatology 1990 criteria)
Time Frame: Time of diagnosis/pre-treatment
|
cranial artery (vertebral, maxillary and temporal) FDG uptake above surrounding tissue FDG uptake is considered consistent with vasculitis
|
Time of diagnosis/pre-treatment
|
Temporal artery biopsy
Time Frame: Time of diagnosis
|
Temporal artery biopsy considered positive in the presence of an inflammatory infiltrate in any vessel wall layer
|
Time of diagnosis
|
Halo sign for monitoring disease activity (week 8, 24 and 15 months)
Time Frame: week 8, 24 and 15 months after initiated treatment
|
Presence or absence of halos on US
|
week 8, 24 and 15 months after initiated treatment
|
Composite halo score for monitoring disease activity (week 8, 24 and 15 months)
Time Frame: week 8, 24 and 15 months after initiated treatment
|
Composite halo score
|
week 8, 24 and 15 months after initiated treatment
|
Intima media thickness for monitoring disease activity (week 8, 24 and 15 months)
Time Frame: week 8, 24 and 15 months after initiated treatment
|
Maximum intima media thickness (IMT) measurement on US
|
week 8, 24 and 15 months after initiated treatment
|
PETVAS for monitoring disease activity (15 months)
Time Frame: 15 months after treatment is initiated
|
Composite PET scores (e.g.PETVAS)
|
15 months after treatment is initiated
|
Semiquantitative FDG measure for monitoring disease activity (15 months)
Time Frame: 15 months after treatment is initiated
|
Maximum semiquantitative FDG measures
|
15 months after treatment is initiated
|
FDG burden for monitoring disease activity (15 months)
Time Frame: 15 months after treatment is initiated
|
Composite scores of FDG inflammatory burden (summarising FDG uptake in voxels of interest)
|
15 months after treatment is initiated
|
PETVAS for GCA prognosis (baseline)
Time Frame: 4-5 years after diagnosis
|
PETVAS score (summarising graded (1-4) FDG uptake in arterial vessel segments)
|
4-5 years after diagnosis
|
Semiquantitative FDG measure for GCA prognosis (baseline)
Time Frame: 4-5 years after diagnosis
|
Maximum semiquantitative FDG measures
|
4-5 years after diagnosis
|
FDG burden for GCA prognosis (baseline)
Time Frame: 4-5 years after diagnosis
|
Composite scores of arterial FDG uptake (summarising FDG uptake in voxels of interest)
|
4-5 years after diagnosis
|
Aortic diameter 4-5 years after diagnosis
Time Frame: 4-5 years after diagnosis
|
Aortic diameter on cross sectional imaging
|
4-5 years after diagnosis
|
Vessel wall thickening 4-5 years after diagnosis
Time Frame: 4-5 years after diagnosis
|
Vessel wall thickening
|
4-5 years after diagnosis
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient global NRS
Time Frame: Baseline, day 10, week 8, 24 and 15 months
|
Patients global experience of disease activity on a numerical range scale (0-10)
|
Baseline, day 10, week 8, 24 and 15 months
|
Physician NRS
Time Frame: Baseline, day 10, week 8, 24 and 15 months
|
Physicians global judgement of disease activity on a numerical range scale (0-10)
|
Baseline, day 10, week 8, 24 and 15 months
|
CRP
Time Frame: Baseline, day 3 and 10, week 8, 24 and 15 months
|
c-reactive protein (mg/l)
|
Baseline, day 3 and 10, week 8, 24 and 15 months
|
Physicians judgement of disease activity
Time Frame: Baseline, day 10, week 8, 24 and 15 months
|
Overall judgement of disease activity (remission, possible activity not requiring treatment, activity/relapse)
|
Baseline, day 10, week 8, 24 and 15 months
|
Cumulated glucocorticoid dose
Time Frame: Baseline, day 10, week 8, 24 and 15 months
|
Cumulated glucocorticoid dose (mg)
|
Baseline, day 10, week 8, 24 and 15 months
|
Glucocorticoid dose
Time Frame: Baseline, day 10, week 8, 24 and 15 months
|
Glucocorticoid dose (mg)
|
Baseline, day 10, week 8, 24 and 15 months
|
Cardiovascular events
Time Frame: 4-5 years
|
Cardiovascular events (number)
|
4-5 years
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Berit Nielsen, MD, Department of rheumatology
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Cerebrovascular Disorders
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Skin Diseases
- Immune System Diseases
- Autoimmune Diseases of the Nervous System
- Autoimmune Diseases
- Musculoskeletal Diseases
- Rheumatic Diseases
- Connective Tissue Diseases
- Muscular Diseases
- Skin Diseases, Vascular
- Vasculitis, Central Nervous System
- Polymyalgia Rheumatica
- Giant Cell Arteritis
- Arteritis
- Vasculitis
Other Study ID Numbers
- ULvsPET GCA cohort
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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