RA: MRI-guided no better than conventional treat-to-target strategy

  • Møller-Bisgaard S & al.
  • JAMA
  • 5 Feb 2019

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • In patients with rheumatoid arthritis (RA) in clinical remission (DAS28-CRP scores

Why this matters

  • Findings do not support adoption of the MRI-guided treat-to-target strategy for disease activity remission and lack of radiographic progression.

Study design

  • Randomized clinical trial of patients with RA in clinical remission (n=200) allocated to an MRI-guided vs a conventional treat-to-target strategy followed for 24 months in IMAGINE-RA.
  • The coprimary outcomes were achievement of DAS28-CRP remission (DAS28-CRP
  • Funding: AbbVie; others.

Key results

  • No difference between the MRI group and the conventional group on the achievement of coprimary outcomes of clinical remission (85.3% vs 88.3%; P=.19) and absence of radiographic progression (66.2% vs 62.4%; P=.25).
  • Serious adverse events were experienced by 17% of the MRI group vs 6% of the conventional group.

Limitations

  • Unblinded design.
  • An imbalance in some baseline characteristics favored the conventional treat-to-target group.
  • Generalizability was reduced because only patients receiving conventional synthetic DMARDs, not biologic DMARDs, were eligible for inclusion.