Ultrasound: promising biomarker for treatment response in very early RA

In patients with VERA on methotrexate + tocilizumab combination therapy, ultrasound imaging was able to detect treatment response in an earlier stage than clinical examination scores.

The open-label TOVERA study offers new insights into ultrasound use for VERA patients

In patients with very early rheumatoid arthritis (VERA) on methotrexate plus tocilizumab combination therapy, ultrasound imaging was able to detect treatment response in an earlier stage than clinical examination scores. Therefore, ultrasound is a potential imaging biomarker of treatment response in this specific patient population.

Ultrasound is an established imaging tool in RA management. Evidence on the applicability of ultrasound in VERA patients on methotrexate plus tocilizumab combination therapy is limited. In the open-label, single-arm, phase 3 TOVERA study (NCT02837146), 44 VERA patients naïve to disease-modifying anti-rheumatic drugs (mean age 46.7) completed the 24-week methotrexate (15–20 mg/week) plus tocilizumab (162 mg/week) induction therapy.

DAS and CDAI only detected treatment response at later stages by comparison

Both grayscale (GS) and GLOESS scores detected a significant treatment response 2 weeks after treatment initiation on the 17-joint score (whole joint set), 12-joint score, and 10-joint score (wrists, MCP, ankles, MTP joints). In contrast, the clinical examination scores Disease Activity Score (DAS)-28 and Clinical Disease Activity Index (CDAI) only detected a significant treatment response at 4 weeks (DAS-28) or 8 weeks (CDAI) of therapy. Patient-reported measures of disease activity –visual analogue scale (VAS) and Health Assessment Questionnaire (HAQ)– detected a first treatment response 8 weeks after the initiation of induction therapy.

According to Dr Maria Stoenoiu (Cliniques Universitaires Saint-Luc, Belgium), who presented the findings of this study, these results demonstrate that ultrasound is a promising imaging biomarker of early treatment response in VERA patients. She concluded that this easy-to-use imaging tool could be used in addition to clinical examination instruments and adds value to the management and monitoring of VERA patients.

Source: Stoenoiu MS, et al. Ultrasound as imaging biomarker of early response to tocilizumab and methotrexate in early rheumatoid arthritis - TOVERA, a longitudinal study. POS0259, EULAR 2021 Virtual Congress, 2-5 June.