Baseline MRI Inflammation May Predict Treatment Response in Early Rheumatoid Arthritis

Magnetic resonance imaging (MRI)-detected inflammation may predict treatment response in patients with early, poor prognosis rheumatoid arthritis (RA), according to study data published in Arthritis Care & Research.

Investigators conducted a post hoc analysis of the Assessing Very Early Rheumatoid arthritis Treatment (AVERT) study (ClinicalTrials.gov Identifier: NCT01142726), a phase 3b randomized controlled trial of patients with early RA (persistent symptoms, ≤2 years). Patient eligibility criteria included Disease Activity State (DAS) 28 (C-reactive protein [CRP]) ≥3.2, active clinical synovitis of ≥2 joints for at least 8 weeks, and anticitrullinated peptide-2 positivity. Patients included in the study had never received methotrexate or had received ≤10 mg/week methotrexate for ≤4 weeks up to a month prior to enrollment.

During the 12-month treatment period, researchers randomly assigned patients 1:1:1 to abatacept plus methotrexate, abatacept monotherapy, or methotrexate monotherapy. They performed an MRI assessment of each patient’s most clinically active hand and wrist at baseline, 6 months, and 12 months. High baseline MRI-detected inflammation indicated poorer RA prognosis. Investigators compared disease activity at 12 months across treatment groups and stratified them according to baseline MRI inflammation levels. Disease activity measures included Simple Disease Activity Index remission, Clinical Disease Activity Index remission, Boolean remission, and DAS28 (CRP).

Of 351 patients enrolled in the AVERT study, 119 received abatacept plus methotrexate and 116 received methotrexate monotherapy. Among these 235 patients, 225 (95.7%) had baseline MRI data available. At baseline, 125 (55.6%) patients were classified as having low MRI inflammation and 100 (44.4%) as having high inflammation. Disease activity scores were significantly greater in the high inflammation group compared with the low inflammation group. Among patients with high baseline inflammation, the percentage of patients achieving remission at 12 months was significantly greater in the abatacept plus methotrexate group than in the methotrexate group. Specifically, compared with the methotrexate monotherapy group, more patients in the abatacept plus methotrexate group achieved remission on the Simple Disease Activity Index (45.1% vs 16.3%; P =.0022), Clinical Disease Activity Index (47.1% vs 20.4%; P =.0065), and Boolean (39.2% vs 16.3%; P =.0156) indices. In addition, a greater percentage of the abatacept plus methotrexate group achieved DAS28 (CRP) <2.6 compared with the methotrexate group (60.8% vs 40.8%; P =.0667), although the difference was not significant. Researchers observed similar trends in the low inflammation group, although abatacept plus methotrexate was not significantly higher than methotrexate monotherapy.

Study limitations included the fact that calculations were from a post hoc analyses and that the AVERT study was not specifically designed to investigate the prognostic ability of baseline MRI inflammation.

“These post hoc analyses of the AVERT study showed that patients with early RA and a high level of MRI inflammation at baseline were more likely to achieve clinical remission with abatacept plus MTX compared with MTX. MRI as a measure of inflammation can provide added value as an objective assessment of disease to influence clinical decision making and guide the more precise use of therapies to treat RA,” the researchers concluded.

Disclosure: This study was supported by Bristol-Myers Squibb Company. Please see the original reference for a full list of authors’ disclosures.

Reference

Ahmad HA, Baker JF, Østergaard M, et al. Baseline objective inflammation by magnetic resonance imaging as a predictor of therapeutic benefit in early, poor prognosis rheumatoid arthritis [published online September 24, 2019]. Arthritis Care Res. doi:10.1002/acr.24072