MRI monitoring of treated RA patients does not improve clinical and radiographic outcomes
medwireNews: Adding the additional target of no osteitis or bone marrow edema (BME) on magnetic resonance imaging (MRI) to a conventional treat-to-target regimen does not improve the clinical or radiographic outcomes of rheumatoid arthritis (RA) patients in clinical remission, IMAGINE-RA study findings show.
The 200 study participants were all in clinical remission, defined as a Disease Activity Score 28 based on C-reaction protein (DAS28-CRP) below 3.2 and no swollen joints, and receiving conventional DMARDs with a treat-to-target strategy to maintain remission within these parameters.
The patients were randomly assigned 1:1 to this strategy alone or with the addition of contrast-enhanced MRI, whereby the 2nd to 5th metacarpophalangeal joints of the dominant hand and dominant wrist were scanned ahead of the clinical visit for the absence of BME and again every 4 months.
Treatment was escalated in patients who had not achieved target, firstly by increasing DMARDs to the maximum dose, adding biologic DMARDs, or switching biologics.
At 2 years, 76 patients in the MRI group and 95 in the conventional treat-to-target group had completed the study. Of these, 85.3% and 88.3%, respectively, had achieved the primary clinical endpoint of remission as defined by DAS28-CRP below 2.6, with no significant difference between them.
As reported at the EULAR 2018 meeting in Amsterdam, the Netherlands, the proportion of patients in each group achieving the radiographic endpoint of no progression (no change in total Sharp/van der Heijde score) was also similar, at a corresponding 66.2% and 62.4%.
Presenting researcher Signe Møller-Bisgaard (Rigshospitalet, Copenhagen, Denmark) noted, however, that more patients in the MRI group than the target-to-treat group achieved secondary outcomes.
We need these kinds of studies to see how we should use MRI, if we should implement MRI
ACR/EULAR Boolean remission was achieved by 49.3% of patients in the MRI group versus 31.9% of those in the standard treat-to-target group, giving an odds ratio of 4.19. And the MRI group had a lower swollen joint count (least square means[LSM] of 0.0 vs 0.3), lower scores on patient visual analog scales for global health/disease activity (LSM of 15.5 vs 21.2 points) and improved physical function and change in Health Assessment Questionnaire score (LSM of ─0.052 vs 0.091).
Møller-Bisgaard concluded: “Targeting absence of MRI BME in addition to a conventional treat-to-target strategy in RA patients in clinical remission had no effect on the probability of achieving DAS28-CRP remission of halting radiographic progression.”
By Lucy Piper
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