Long-term efficacy of a 2-year MRI treat-to-target strategy on disease activity and radiographic progression in patients with rheumatoid arthritis in clinical remission: 5-year follow-up of the IMAGINE-RA randomised trial
Merete Lund Hetland,
Hanne Lindegaard,
Oliver Hendricks,
Niels Steen Krogh,
Robin Christensen,
Mikkel Østergaard,
Mikael Boesen,
Ellen Margrethe Hauge,
Lykke Midtbøll Ørnbjerg,
Daniel Glinatsi,
Sabrina Mai Nielsen,
Kim Hørslev-Petersen,
Bo Ejbjerg,
Kristian Stengaard-Pedersen,
Ole Rintek Madsen,
Jan Alexander Villadsen,
Henrik Thomsen,
Signe Møller-Bisgaard,
Bente Jensen,
Jakob Møllenbach Møller
Affiliations
Merete Lund Hetland
5 Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
Hanne Lindegaard
16 Department of Rheumatology, Odense University Hospital, Odense, Denmark
Oliver Hendricks
3Rheumatology and Radiology departments at hospitals at Zealand, Jutland and Funen, Copenhagen, Slagelse, Aarhus, Silkeborg, Odense, Hjørring and Graasten, Denmark
Niels Steen Krogh
EurSA Research Collaboration, on behalf of DANBIO (Denmark), ARTIS (Sweden), SCQM (Switzerland), NOR-DMARD (Norway), ATTRA (Czech Republic), Reuma.pt (Portugal), BIOBADASER (Spain), ROB-FIN (Finland), biorx.si (Slovenia), ICEBIO (Iceland), TURKBIO (Turkey), RRBR (Romania), ARC (Netherlands), BSRBR-AS (UK), GISEA (Italy), Denmark
Robin Christensen
Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
Mikkel Østergaard
5 Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
Mikael Boesen
3University of Copenhagen and Bispebjerg Hospital, Copenhagen, Denmark
Ellen Margrethe Hauge
1Aarhus University Hospital, Department of Rheumatology, aarhus, Denmark
Lykke Midtbøll Ørnbjerg
Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
Daniel Glinatsi
3Rigshospitalet, Glostrup, Center for Rheumatology and Spine Diseases, Copenhagen, Denmark
Sabrina Mai Nielsen
1Bispebjerg-Frederiksberg Hospital, University of Copenhagen, The Parker Institute, Frederiksberg, Denmark
Kim Hørslev-Petersen
13 Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
13 Department of Rheumatology, Gentofte University Hospital, Hellerup, Denmark
Jan Alexander Villadsen
15 Department of Rheumatology, Silkeborg Regional Hospital, Silkeborg, Denmark
Henrik Thomsen
3Rheumatology and Radiology departments at hospitals at Zealand, Jutland and Funen, Copenhagen, Slagelse, Aarhus, Silkeborg, Odense, Hjørring and Graasten, Denmark
Signe Møller-Bisgaard
1Rigshospitalet, Glostrup, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark
Bente Jensen
3Rheumatology and Radiology departments at hospitals at Zealand, Jutland and Funen, Copenhagen, Slagelse, Aarhus, Silkeborg, Odense, Hjørring and Graasten, Denmark
Jakob Møllenbach Møller
5Department of Radiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
Objective To investigate whether a 2-year MRI treat-to-target strategy targeting the absence of osteitis combined with clinical remission, compared with a conventional treat-to-target strategy targeting clinical remission only (IMAGINE-rheumatoid arthritis (RA) trial) improves clinical and radiographic outcomes over 5 years in patients with RA in clinical remission.Methods IMAGINE-more was an observational extension study of the original 2-year IMAGINE-RA randomised trial (NCT01656278). Clinical examinations and radiographs (hands and feet) were obtained yearly. Prespecified coprimary outcomes at year 5 were Disease Activity Score in 28 joints C reactive protein (DAS28-CRP) remission rate (DAS28-CRP<2.6) and no radiographic progression (van der Heijde-modified Sharp score (vdHSS) ≤0) from baseline. Secondary outcomes included 5-year changes in radiographic, MRI and clinical measures of disease activity and physical function.Results In total 131 patients, 86 women (67%), mean age 61.2, disease duration 9.5 years, median baseline DAS28-CRP 1.9 (IQR 1.6–2.2) and vdHSS 16.0 (IQR 7.0–36.0) were included in the study; 59 (59%) patients from the original MRI treat-to-target group and 72 (72%) from the conventional group. At year 5, 47 patients (80%) in the MRI treat-to-target group vs 54 patients (75%) in the conventional treat-to-target group were in DAS28-CRP remission (OR 2.00 (95% CI 0.76 to 5.28); p=0.16) while 14 patients (24%) vs 19 patients (26%) had no radiographic progression (OR 0.70, (95% CI 0.28 to 1.71); p=0.43).Conclusion A 2-year combined MRI and clinical treat-to-target strategy, compared with a conventional clinical treat-to-target strategy alone, had no effect on the long-term probability of achieving DAS28-CRP remission and of avoiding radiographic progression.
