Value of ultrasonography as a marker of early response to abatacept in patients with rheumatoid arthritis and an inadequate response to methotrexate: Results from the APPRAISE study

Maria Antonietta D'Agostino, Richard J. Wakefield, Hilde Berner-Hammer, Olivier Vittecoq, Georgios Filippou, Peter Balint, Ingrid Möller, Annamaria Iagnocco, Esperanza Naredo, Mikkel Østergaard, Maarten Boers, Corine Gaillez, Karina Van Holder, Manuela Le Bars

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Abstract

Objectives To study the responsiveness of a combined power Doppler and greyscale ultrasound (PDUS) score for assessing synovitis in biologic-naave patients with rheumatoid arthritis (RA) starting abatacept plus methotrexate (MTX). Methods In this open-label, multicentre, single-arm study, patients with RA (MTX inadequate responders) received intravenous abatacept (∼10 mg/kg) plus MTX for 24 weeks. A composite PDUS synovitis score, developed by the Outcome Measures in Rheumatology- European League Against Rheumatism (OMERACT- EULAR)-Ultrasound Task Force, was used to evaluate individual joints. The maximal score of each joint was added into a Global OMERACT-EULAR Synovitis Score (GLOESS) for bilateral metacarpophalangeal joints (MCPs) 2-5 ( primary objective). The value of GLOESS containing other joint sets was explored, along with clinical efficacy. Results Eighty-nine patients completed the 24-week treatment period. The earliest PDUS sign of improvement in synovitis was at week 1 (mean change in GLOESS (MCPs 2-5): -0.7 (95% CIs -1.2 to -0.1)), with continuous improvement to week 24. Early improvement was observed in the component scores (power Doppler signal at week 1, synovial hyperplasia at week 2, joint effusion at week 4). Comparable changes were observed for 22 paired joints and minimal joint subsets. Mean Disease Activity Score 28 (C reactive protein) was significantly reduced from weeks 1 to 24, reaching clinical meaningful improvement (change ≥1.2) at week 8. Conclusions In this first international prospective study, the composite PDUS score is responsive to abatacept. GLOESS demonstrated the rapid onset of action of abatacept, regardless of the number of joints examined. Ultrasound is an objective tool to monitor patients with RA under treatment.

Original languageEnglish
Pages (from-to)1763-1769
Number of pages7
JournalAnnals of the rheumatic diseases
Volume75
Issue number10
DOIs
Publication statusPublished - Oct 1 2016

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

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    D'Agostino, M. A., Wakefield, R. J., Berner-Hammer, H., Vittecoq, O., Filippou, G., Balint, P., Möller, I., Iagnocco, A., Naredo, E., Østergaard, M., Boers, M., Gaillez, C., Van Holder, K., & Le Bars, M. (2016). Value of ultrasonography as a marker of early response to abatacept in patients with rheumatoid arthritis and an inadequate response to methotrexate: Results from the APPRAISE study. Annals of the rheumatic diseases, 75(10), 1763-1769. https://doi.org/10.1136/annrheumdis-2015-207709