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Baseline Objective Inflammation by Magnetic Resonance Imaging as a Predictor of Therapeutic Benefit in Early Rheumatoid Arthritis With Poor Prognosis
Author(s) -
Ahmad Harris A.,
Baker Joshua F.,
Østergaard Mikkel,
Emery Paul,
Durez Patrick,
Ye June,
Banerjee Subhashis,
Conaghan Philip G.
Publication year - 2020
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.24072
Subject(s) - medicine , rheumatoid arthritis , methotrexate , abatacept , magnetic resonance imaging , synovitis , inflammation , gastroenterology , arthritis , tocilizumab , oncology , radiology , rituximab , lymphoma
Objective High magnetic resonance imaging ( MRI )–detected inflammation is associated with greater progression and poorer outcomes in rheumatoid arthritis ( RA ). This analysis aimed to determine if baseline MRI inflammation was related to clinical response and remission in the Assessing Very Early Rheumatoid arthritis Treatment ( AVERT ) study. Methods AVERT was a phase III b, randomized, controlled trial with a 12‐month, double‐blind treatment period enrolling patients with early (≤2 years' duration), anti‐citrullinated peptide–positive methotrexate ( MTX )‐naive RA . In this post hoc analysis, patients in the abatacept plus MTX (n = 114) and MTX (n = 111) arms with available MRI results were stratified into low and high baseline MRI inflammation groups based on previously developed cutoffs of synovitis and osteitis on unilateral hand–wrist contrast‐enhanced MRI . Simplified Disease Activity Index ( SDAI ) remission (≤3.3), Clinical Disease Activity Index ( CDAI ) remission (≤2.8), Boolean remission, and Disease Activity Score in 28 joints using the C‐reactive protein level (<2.6) were assessed. Results Overall, 100 of 225 patients (44.4%) had high baseline MRI inflammation. In patients with high baseline MRI inflammation, a significantly greater proportion achieved remission at 12 months with abatacept plus MTX versus MTX across SDAI (45.1% versus 16.3%; P = 0.0022), CDAI (47.1% versus 20.4%; P = 0.0065), and Boolean indices (39.2% versus 16.3%; P = 0.0156). In patients with low baseline MRI inflammation, remission rates were not significantly different with abatacept plus MTX versus MTX ( SDAI : 39.7% versus 32.3%; P = 0.4961). Conclusion In seropositive, MTX ‐naive patients with early RA and presence of objectively measured high inflammation by MRI , indicating poor prognosis, remission rates were higher with abatacept plus MTX treatment versus MTX .