Early MRI response to RA therapy predicts long-term progression better than disease activity
MRI changes recorded as early as 1 month after the start of treatment for rheumatoid arthritis may be a better predictor of long-term radiographic progression than disease activity measures, according to data published in Arthritis Research & Therapy.
“We have known for years that there is a discrepancy between clinical disease activity measures such as DAS, and objective measures of inflammation using imaging,” Philip G. Conaghan, MBBS, PhD, FRACP, FRCP, of the University of Leeds and the UK National Institute for Health Research Leeds Biomedical Research Center, told Healio Rheumatology.
“Magnetic resonance imaging (MRI) can assess inflammation (synovitis and bone marrow edema/osteitis) as well as damage (erosions) in joints, using the semiquantitative Outcome Measures in Rheumatology (OMERACT) RA MRI scoring system (RAMRIS) and, more recently, the automated quantitative RA MRI assessment system (RAMRIQ; automated RAMRIS),” Conaghan and colleagues wrote. “This sensitivity for pathology detection may provide a tool for accurate early detection of an objective treatment response.”
To evaluate early changes in MRI and disease activity measures as predictors of radiographic progression in patients with early RA, Conaghan and colleagues conducted a post hoc analysis of data from a phase 2, exploratory, randomized, double-blind, parallel-group study. In this study, adult patients who had active RA for 2 years or fewer were randomly assigned to receive either 10 mg of tofacitinib (Xeljanx, Pfizer) monotherapy twice daily, 10 mg of tofacitinib with methotrexate or methotrexate monotherapy. Among the 109 participants, 103 had not previously received methotrexate.
In the phase 2 study, researchers assessed synovitis, osteitis and erosions using the OMERACT, RAMRIS and RAMRIQ, at 0, 1, 3, 6 and 12 months. In addition, they assessed radiographs at 0, 6 and 12 months, and clinical endpoints at all follow-up visits. Conaghan and colleagues analyzed data from 109 patients with a mean RA duration of 0.7 years. They used univariate and multivariate analyses to determine the predictive value of early RAMRIS and RAMRIQ changes, compared with disease activity measures, related to later radiographic progression.
According to the researchers, the univariate analyses demonstrated that changes in RAMRIS erosions at months 1 and 3 significantly predicted radiographic progression at 1 year (P< .01). Additionally, RAMRIQ changes in synovitis and osteitis at months 1 and 3 were also significant predictors of RAMRIS erosions and radiographic progression at 1 year (P<.01). Multivariate analyses demonstrated that RAMRIS erosion change at 1 month (P<.05), as well as RAMRIQ osteitis changes at months 1 and 3 (P<.01), were significant independent predictors of 1-year radiographic progression.
“Here we showed that early responses on objective imaging, at three months and even at one month after starting an effective therapy, predicted a better patient outcome, measured in terms of X-ray progression,” Conaghan said. “This paper does not mean everyone needs an MRI, but it does say that if we want to know quickly who is getting the best response to a drug, we should look early with sensitive assessments.”
“In the real world — not clinical trials — this might mean using ultrasound assessment one month after starting therapy,” he added. “However, it depends on your health system, ease of access to ultrasound and whether you can change therapies subsequently. Cost may prohibit biologic therapy switching.” – by Jason Laday
Disclosure: Conaghan reports consulting fees from AbbVie, Eli Lilly, Flexion, GlaxoSmithKline, Novartis, Pfizer and Roche, as well as speaking fees from AbbVie, Novartis and Roche. Please see the study for all other authors’ relevant financial disclosures.