Researchers observed significant changes in the Berlin and Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) inflammation scores and the SPARCC MRI-assessed erosion scores within 12 weeks of adalimumab treatment, according to data recently published in Arthritis and Rheumatology.
The Berlin and SPARCC methods were developed to assess structural lesions of the sacroiliac (SI) joints in patients with axial spondyloarthritis (SpA). The Berlin method uses semiqualitative grading of lesions to determine the percentage involvement of the subchondral bone marrow, while the SPARCC method assesses lesions based on individual MRI slices. Researchers used both methods to investigate MRI-assessed inflammation and structural lesions during treatment with adalimumab.
Among the 52 patients included in the study, 25 were randomly assigned to receive subcutaneous injections of adalimumab 40 mg and 27 were assigned to the placebo group. Participants received injections every other week for 12 weeks. After 12 weeks, the patients in the adalimumab group continued treatment and patients in the placebo group were switched to adalimumab 40 mg injections for an additional 12 weeks.
The participants underwent MRI of the SI joints at 0, 12, 24, and 48 weeks. Researchers assessed the images using the Berlin and SPARCC scores.
At the start of the study, 56% of patients taking adalimumab and approximately 72% of the placebo group had an MRI-assessed inflammation score ≥1. Among these patients, the mean reduction rates for MRI inflammation scores were greater in the adalimumab group than the placebo group. Using the Berlin method, the adalimumab group had a reduction of 62% vs 5% in the placebo group, while the SPARCC method revealed a 58% reduction vs 12% for placebo (P<.04).
The mean SPARCC erosion score also decreased (-0.6) in the adalimumab group and the SPARCC backfill score increased (+0.8) within the 12 weeks.
From week 12 to week 24, patients taking adalimumab had larger absolute reductions in the Berlin and SPARCC inflammation scores and the SPARCC erosion scores. There were also larger increases in the Berlin and SPARCC fatty lesion scores in the placebo group compared with the adalimumab group.
“Treatment was independently associated with resolution of erosions,” the authors concluded. “Thus, MRI-assessed structural lesions (fatty lesions, erosion, and backfill) change rapidly and may have value for the assessment of disease-modifying treatment effects in clinical trials.”
Summary and Clinical Applicability
Changes in the SI joints were observed after only 12 weeks of active adalimumab treatment in clinical measures of disease activity, the Berlin and SPARCC MRI scores for inflammation, fatty lesions, and the SPARCC erosion and backfill scores. MRI assessments were sensitive enough to detect changes in structural lesions early in disease and may have value for evaluating efficacy of disease-modifying treatment.
Pedersen SJ, Poddubnyy D, Sorensen IJ, et al. Course of magnetic resonance imaging-detected inflammation and structural lesions in the sacroiliac joints of patients in the randomized, double-blind, placebo-controlled Danish multicenter study of adalimumab in spondyloarthritis, as assessed by the Berlin and Spondyloarthritis Research Consortium of Canada Methods. Arthritis Rheum. 2016;68(2):418-429. doi: 10.1002/art.39434.