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Very early MRI responses to therapy as a predictor of later radiographic progression in early rheumatoid arthritis

Author

Conaghan PG1, Østergaard M2, Troum O3, Bowes MA4, Guillard G4, Wilkinson B5, Xie Z5, Andrews J6, Stein A7, Chapman D6, Koenig A8. Arthritis Res Ther. 2019 Oct 21;21(1):214. doi: 10.1186/s13075-019-2000-1.

Author Information

1 Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and UK National Institute for Health Research Leeds Biomedical Research Centre, Leeds, UK. P.Conaghan@leeds.ac.uk.

2 Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

3 Division of Rheumatology, University of Southern California Keck School of Medicine, Santa Monica, CA, USA.

4 Imorphics Ltd, Worthington House, Towers Business Park, Manchester, UK.

5 Pfizer Inc, Groton, CT, USA.

6 Pfizer Inc, New York, NY, USA.

7 Biostatistics Department, IQVIA Inc, Morrisville, NC, USA.

8 Pfizer Inc, Collegeville, PA, USA.

Abstract

BACKGROUND: 

The objective of this study was to evaluate early changes in magnetic resonance imaging (MRI) and clinical disease activity measures as predictors of later structural progression in early rheumatoid arthritis (RA).

METHODS: 

This was a post hoc analysis of data pooled across treatments from a three-arm (tofacitinib monotherapy, tofacitinib with methotrexate [MTX], or MTX monotherapy) trial of MTX-naïve patients with early, active RA. Synovitis, osteitis and erosions were assessed with the Outcome Measures in Rheumatology (OMERACT) RA MRI scoring system (RAMRIS) and RAMRIQ (automated quantitative RA MRI assessment system; automated RAMRIS) at months 0, 1, 3, 6 and 12. Radiographs were assessed at months 0, 6 and 12, and clinical endpoints were assessed at all timepoints. Univariate and multivariate analyses explored the predictive value of early changes in RAMRIS/RAMRIQ parameters and disease activity measures, with respect to subsequent radiographic progression.

RESULTS: 

Data from 109 patients with a mean RA duration of 0.7 years were included. In univariate analyses, changes in RAMRIS erosions at months 1 and 3 significantly predicted radiographic progression at month 12 (both p <  0.01); changes in RAMRIQ synovitis and osteitis at months 1 and 3 were significant predictors of RAMRIS erosions and radiographic progression at month 12 (all p <  0.01). In subsequent multivariate analyses, RAMRIS erosion change at month 1 (p <  0.05) and RAMRIQ osteitis changes at months 1 and 3 (both p <  0.01) were significant independent predictors of radiographic progression at month 12. Univariate analyses demonstrated that changes in Clinical Disease Activity Index (CDAI) and Disease Activity Score in 28 joints, erythrocyte sedimentation rate (DAS28-4[ESR]) at months 1 and 3 were not predictive of month 12 radiographic progression.

CONCLUSIONS: 

MRI changes seen as early as 1 month after RA treatment initiation have the potential to better predict long-term radiographic progression than changes in disease activity measures.

TRIAL REGISTRATION: 

ClinicalTrials.gov, NCT01164579 .