POS0052 FIVE-YEAR FOLLOW-UP OF A 2-YEAR MRI TREAT-TO-TARGET STRATEGY ON RADIOGRAPHIC DAMAGE PROGRESSION IN RHEUMATOID ARTHRITIS PATIENTS IN CLINICAL REMISSION - THE IMAGINE-MORE STUDY

S. Møller-bisgaard, K. Hørslev-petersen, L. Midtbøll Ørnbjerg, B. Ejbjerg, M.l. Hetland, J. Møllenbach Møller, R. Christensen, S.m. Nielsen, D. Glinatsi, M. Boesen, K. Stengaard-pedersen, O. Madsen, B. Jensen, J.a. Villadsen, E.m. Hauge, O. Hendricks, H.m. Lindegaard, N. Steen Krogh, A.g. Jurik, H. ThomsenM. Østergaard

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Abstract

Background
Radiographic joint damage progresses in 20-30% of rheumatoid arthritis (RA) patients despite fulfilling clinical remission criteria [1]. Osteitis assessed on MRI predicts subsequent bone damage progression [2]. Therefore, targeting absence of osteitis combined with clinical remission may improve long-term radiographic outcomes.
Objectives
To investigate whether a 2-year MRI treat-to-target (MRI T2T) strategy targeting absence of osteitis combined with clinical remission, compared to a conventional T2T strategy targeting clinical remission only, could reduce radiographic joint damage progression over 5 years in RA patients.
Methods
IMAGINE-more was designed as a three-year observational extension study of the 2-year IMAGINE-RA randomized clinical trial [3]. IMAGINE-RA included 200 RA patients in clinical remission (DAS28-CRP<3.2 and no swollen joints), with erosive disease (bone erosion on conventional radiography), and treated with csDMARDs. The objective was to investigate whether an MRI T2T strategy targeting absence of osteitis combined with clinical remission (DAS28-CRP≤3.2 and no swollen joints) as compared to a conventional T2T strategy, targeting clinical remission only, could improve remission rates and prevent radiographic joint damage progression. If treatment target was not met, treatment was intensified stepwise starting with increment in csDMARDs and subsequently adding biologics. Participants in the IMAGINE-more study were managed in routine clinical practice in outpatient clinics. Clinical examinations and radiographs of hands and feet (also obtained at baseline, year 1 and 2 in IMAGINE-RA) were done year 3, 4 and 5. The primary endpoint was the proportion of patients with no radiographic progression (increase in total van der Heijde-modified Sharp score (vdHSS) ≤0) from baseline to year 5. Secondary endpoints were 0-5 years changes in total vdHSS, vdHSS erosion and joint space narrowing (JSN) scores. Dichotomous endpoints were estimated by logistic regression, while median differences were calculated for the continuous outcome measures.
Results
Informed consent to participation in IMAGINE-more was obtained from 131 patients (59 from the original MRI T2T group). Of these, 14 patients (24%) in the MRI T2T group and 19 patients (26%) in the conventional T2T group had no radiographic progression from baseline to year 5 (OR 0.70 [0.28 to 1.71]). As illustrated in the Table 1 and Figure 1, the median progression in total vdHSS from baseline to 5 years was low, with no differences between treatment groups.
Original languageEnglish
JournalAnnals of the Rheumatic Diseases
Volume82
Issue numberSuppl 1
Pages (from-to)235-236
Number of pages2
ISSN0003-4967
DOIs
Publication statusPublished - 2023

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