MRI-guided Tx strategy not superior for rheumatoid arthritis
Signe Møller Bisgaard, M.D., Ph.D., from Slagelse Hospital in Denmark, and colleagues conducted a two-year multicenter trial at nine hospitals involving 200 patients with RA in clinical remission (disease activity score in 28 joints-C-reactive protein [DAS28-CRP] <3.2 and no swollen joints). Patients were randomly assigned to an MRI-guided versus a conventional treat-to-target strategy. The coprimary outcomes at 24 months were the proportion of patients achieving DAS28-CRP remission (<2.6) and no radiographic progression (no increase in the van der Heijde-modified Sharp score).
The researchers found that 76 and 95 percent of patients in the MRI-guided and conventional groups, respectively, completed the study. Of these, 85 and 88 percent, respectively, reached the primary clinical end point (risk difference, −4.8 percent), while 66 versus 62 percent, respectively, reached the primary radiographic end point (risk difference, 4.7 percent). Eight of 10 key secondary end points were null, and two showed statistically significant benefit for the MRI treat-to-target group. Serious adverse events were experienced by 17 and 6 percent of patients in the MRI-guided and conventional groups, respectively.
"These findings do not support the use of an MRI-guided strategy for treating patients with RA," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
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