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Ahmad HA, Baker JF, Østergaard M, Emery P, Durez P, Ye J, Banerjee S, Conaghan PG. Baseline Objective Inflammation by Magnetic Resonance Imaging as a Predictor of Therapeutic Benefit in Early, Poor Prognosis Rheumatoid Arthritis. Arthritis care & research. 2019 Sep 24.
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Abstract: OBJECTIVE: High magnetic resonance imaging (MRI)-detected inflammation is associated with greater progression and poorer outcomes in rheumatoid arthritis (RA). This analysis aimed to determine if baseline MRI inflammation was related to clinical response and remission in the Assessing Very Early Rheumatoid arthritis Treatment (AVERT) study. METHODS: AVERT was a Phase IIIb, randomized, controlled trial with a 12-month, double-blind treatment period enrolling patients with early ( 2 years' duration), anti-citrullinated peptide-positive methotrexate (MTX)-naïve RA. In this post hoc analysis, patients in the abatacept+MTX (n = 114) and MTX (n = 111) arms with available MRI were stratified into low and high baseline MRI inflammation groups based on previously developed cut-offs of synovitis and osteitis on unilateral hand-wrist contrast-enhanced MRI. Simplified Disease Activity Index (SDAI) remission ( 3.3), Clinical Disease Activity Index (CDAI) remission ( 2.8), Boolean remission, and Disease Activity Score in 28 joints (C-reactive protein) (DAS28 [CRP] < 2.6) were assessed. RESULTS: Overall, 100/225 (44.4%) patients had high baseline MRI inflammation. In patients with high baseline MRI inflammation, a significantly greater proportion achieved remission at 12 months with abatacept+MTX versus MTX, across SDAI (45.1% vs 16.3%; P = 0.0022), CDAI (47.1% vs 20.4%; P = 0.0065) and Boolean indices (39.2% vs 16.3%; P = 0.0156). In patients with low baseline MRI inflammation, remission rates were not significantly different with abatacept+MTX versus MTX (SDAI: 39.7% vs 32.3%; P = 0.4961). CONCLUSION: In seropositive, MTX-naïve patients with early RA, presence of objectively measured high inflammation by MRI, indicating poor prognosis, remission rates were higher with abatacept+MTX treatment versus MTX.

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