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

Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review


  • Harris A. Ahmad
  • Joshua F. Baker
  • Philip G. Conaghan
  • Paul Emery
  • Thomas W.J. Huizinga
  • Yedid Elbez
  • Subhashis Banerjee
  • Mikkel Østergaard
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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:, NCT01142726 (date of registration: June 11, 2010).

TidsskriftArthritis Research and Therapy
Udgave nummer1
StatusUdgivet - dec. 2022

Bibliografisk note

Funding Information:
Professor Conaghan has received grant/research support from Bristol Myers Squibb, consulting fees from AbbVie, GlaxoSmithKline, Eli Lilly, Novartis, Pfizer, and Roche, and speaking fees from AbbVie, Bristol Myers Squibb, and Novartis. Professor Emery has received consulting fees from AbbVie, Bristol Myers Squibb, Eli Lilly, Merck, Novartis, Pfizer, Roche, and Samsung Bioepis. Professor Huizinga has received grant/research support from the EU & Dutch Arthritis Foundation, consulting fees from Abbott Laboratories, Biotest AG, Bristol Myers Squibb, Crescendo Biosciences, Eli Lilly, Novartis, Pfizer, Roche, Sanofi-Aventis, Schering-Plough, and UCB, and speaking fees from Abbott Laboratories, Biotest AG, Bristol Myers Squibb, Novartis, Pfizer, Pharmaceuticals Corporation, Roche, Sanofi-Aventis, and Schering-Plough. Mr. Elbez received consulting fees from Bristol Myers Squibb. Dr. Banerjee is an employee of and shareholder in Bristol Myers Squibb. Professor Østergaard has received grant/research support from AbbVie, Bristol Myers Squibb, Janssen, and Merck, and speaking fees from AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Centocor, Eli Lilly, GlaxoSmithKline, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Schering-Plough, Takeda, UCB, and Wyeth.

Funding Information:
This study was sponsored by Bristol Myers Squibb. Professor Emery and Professor Conaghan are funded in part by the UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK Department of Health and Social Care.

Publisher Copyright:
© 2022, The Author(s).

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