Prediction of flare following remission and treatment withdrawal in early rheumatoid arthritis: post hoc analysis of a phase IIIb trial with abatacept.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101154438 Publication Model: Electronic Cited Medium: Internet ISSN: 1478-6362 (Electronic) Linking ISSN: 14786354 NLM ISO Abbreviation: Arthritis Res Ther Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, 2003-
    • Subject Terms:
      Abatacept*/therapeutic use ; Antirheumatic Agents*/therapeutic use ; Arthritis, Rheumatoid*/diagnostic imaging ; Arthritis, Rheumatoid*/drug therapy; Drug Therapy, Combination ; Humans ; Remission Induction ; Treatment Outcome
    • Abstract:
      Background: Drug-free remission is a desirable goal in rheumatoid arthritis (RA) for both patients and clinicians. The aim of this post hoc analysis was to investigate whether clinical and magnetic resonance imaging (MRI) variables in patients with early RA who achieved remission with methotrexate and/or abatacept at 12 months could predict disease flare following treatment withdrawal.
      Methods: In the AVERT study of abatacept in early RA, patients with low disease activity at month 12 entered a 12-month period with all treatment discontinued (withdrawal, WD). This post hoc analysis assessed predictors of disease flare at WD+6months (mo) and WD+12mo of patients with Disease Activity Score in 28 joints (DAS28)-defined remission (DAS28[C-reactive protein (CRP)] <2.6) at withdrawal using univariate and multivariable regression models. Predictors investigated included the Health Assessment Questionnaire-Disability Index (HAQ-DI), pain, Patient Global Assessment; MRI synovitis, erosion, bone edema, and combined (synovitis + bone edema) inflammation scores.
      Results: Remission was achieved by 172 patients; 100 (58%) and 113 (66%) patients had experienced a flare at WD+6mo and WD+12mo, respectively. In univariate analyses, higher HAQ-DI and MRI synovitis, erosion, bone edema, and combined inflammation scores at WD were identified as potential predictors of flare (P ≤ 0.01). In multivariable analysis, high scores at WD for HAQ-DI and MRI erosion were confirmed as independent predictors of flare at WD+6mo and WD+12mo (P < 0.01).
      Conclusion: In patients with early RA achieving clinical remission, patient function (HAQ-DI), and MRI measures of bone damage (erosion) predicted disease flare 6 and 12 months after treatment withdrawal. These variables may help identify patients with early RA in clinical remission as candidates for successful treatment withdrawal.
      Trial Registration: ClinicalTrials.gov, NCT01142726 (date of registration: June 11, 2010).
      (© 2022. The Author(s).)
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    • Grant Information:
      United Kingdom DH_ Department of Health
    • Contributed Indexing:
      Keywords: Abatacept; Disease-modifying antirheumatic drugs (DMARDs); Flare; Magnetic resonance imaging (MRI); Rheumatoid arthritis
    • Molecular Sequence:
      ClinicalTrials.gov NCT01142726
    • Accession Number:
      0 (Antirheumatic Agents)
      7D0YB67S97 (Abatacept)
    • Publication Date:
      Date Created: 20220217 Date Completed: 20220310 Latest Revision: 20240823
    • Publication Date:
      20240823
    • Accession Number:
      PMC8848810
    • Accession Number:
      10.1186/s13075-022-02735-8
    • Accession Number:
      35172859