Evidence map›Paper›PMID 34269927›Full record

ArticleClinical rheumatology2021

Doppler ultrasound impacts response to intravenous tocilizumab in rheumatoid arthritis patients.

Nicolette T Morris, Jenny Brook, Ami Ben-Artzi, William Martin, Tanaz A Kermani, Lynette Avedikian-Tatosyan, George Karpouzas, Himakar Nagam, Geraldine Navarro, Soo Choi and 4 more

Registry-linked trialAbstract read
PubMed Publisher
In one paragraph

Article in Clinical rheumatology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01717859 (Musculoskeletal Ultrasound in Predicting Early Dose Titration With Tocilizumab), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.3field-weighted citation impact, top 40% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01717859 phase4completednot on this map

Musculoskeletal Ultrasound in Predicting Early Dose Titration With Tocilizumab

TypeinterventionalSponsorUniversity of California, Los AngelesRan2014 to 2017Enrolled74ConditionsRheumatoid ArthritisArmsTocilizumab
3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 4 citations in OpenAlex.

  1. Review
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 6 institutions in 1 country.

Nicolette T MorrisDivision of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, 1000 Veteran Avenue, Box 32-59, Los Angeles, CA, 90024, USA.
Jenny BrookDepartment of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Ami Ben-ArtziDivision of Rheumatology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
William MartinDivision of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, 1000 Veteran Avenue, Box 32-59, Los Angeles, CA, 90024, USA.
Tanaz A KermaniDivision of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, 1000 Veteran Avenue, Box 32-59, Los Angeles, CA, 90024, USA.
Lynette Avedikian-TatosyanHealthcare Partners, Los Angeles, CA, USA.
George KarpouzasDivision of Rheumatology, Harbor-UCLA Medical Center, Los Angeles, CA, USA.
Himakar NagamUniversity of California, Irvine, School of Medicine, Irvine, CA, USA.
Geraldine NavarroDivision of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, 1000 Veteran Avenue, Box 32-59, Los Angeles, CA, 90024, USA.
Soo ChoiDivision of Rheumatology, School of Medicine, University of California, San Diego, San Diego, CA, USA.
Mihaela B TaylorDivision of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, 1000 Veteran Avenue, Box 32-59, Los Angeles, CA, 90024, USA.
David ElashoffDepartment of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Gurjit S Kaeley *Division of Rheumatology and Clinical Immunology, College of Medicine, University of Florida, Jacksonville, Jacksonville, FL, USA.
Veena K Ranganath *Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, 1000 Veteran Avenue, Box 32-59, Los Angeles, CA, 90024, USA. vranganath@mednet.ucla.edu.ORCID http://orcid.org/0000-0003-3417-9478
University of California, Los Angeles · USCedars-Sinai Medical Center · USHarbor–UCLA Medical Center · USUniversity of California, Irvine · USUniversity of California San Diego · USUniversity of Florida · US

Funding

genentech ML28542
6 · The paper itself

Abstract

objectiveWithin rheumatoid arthritis (RA) patients treated with intravenous tocilizumab (IV-TCZ), it is unclear if power Doppler ultrasonography (PDUS) can predict future clinical response. This study sought to determine if baseline PDUS or its early changes can predict 12-week and 24-week disease activity outcomes, and quantify the need for dose escalation (4 to 8 mg/kg).

methodsFifty-four RA patients starting IV-TCZ were evaluated at baseline, 4, 6, 12, 16, and 24 weeks using 34-joint PDUS (US34-PDUS), clinical disease activity index (CDAI), 28-joint disease activity score using erythrocyte sedimentation rate (DAS28-ESR), ACR 20/50/70, health assessment questionnaire-disability index (HAQ-DI), and PDUS 20/50/70, a novel measure. Logistic regression models evaluated the predictive utility of US34-PDUS of DAS28-ESR response after adjusting for covariates.

resultsNinety-four percent of patients required dose escalation to 8 mg/kg. US34-PDUS, CDAI, and DAS28-ESR improved significantly over 24 weeks (p < 0.001). Baseline PDUS and 12-week PDUS change correlated with CDAI at 24 weeks (p < 0.05). Logistic regression demonstrated baseline US34-PDUS was independently associated with DAS28-ESR ≥ 1.2 response, even after adjusting for baseline DAS28-ESR (p = 0.03). CDAI, DAS28-ESR, and their components increased across PDUS 20/50/70 categories; however, HAQ-DI did not.

conclusionRA patients treated with IV-TCZ for 24 weeks demonstrated significant improvement, and baseline/early changes in PDUS were predictive of later clinical response. The PDUS 20/50/70 measure is a novel metric of response. This study suggests that IV-TCZ 4 mg/kg may not be sufficient to attain low RA disease activity at 12 weeks, in RA patients with moderate to severe disease (DAS28 ≥ 4.4 and US34-PDUS ≥ 10).

trial registrationClinicalTrials.gov NCT01717859 Key Points • Over 90% of RA patients with baseline DAS28-ESR ≥ 4.4 and PDUS34 ≥ 10 required intravenous tocilizumab dose escalation from 4 to 8 mg/kg at 12 weeks. • Reduction in power Doppler ultrasonography (US34-PDUS) scores correlate with DAS28-ESR and CDAI over 24 weeks in rheumatoid arthritis patients with moderate to severe disease activity. • Baseline US34-PDUS predicts future improvements in clinical disease activity outcomes, independent of baseline DAS28-ESR. • Clinical response measures, DAS28-ESR and CDAI, improved across US34-PDUS 20/50/70 categories, while patient-reported outcomes did not.

Indexed as

Antirheumatic AgentsArthritis, RheumatoidAntibodies, Monoclonal, HumanizedHumansSeverity of Illness IndexTreatment OutcomeUltrasonography, DopplerAntibodies, Monoclonal, HumanizedAntirheumatic AgentstocilizumabBiological therapyOutcomesRheumatoid arthritisUltrasonography

Identifiers

PMID34269927
OpenAlexW3180368537

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.