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Abstract
Objective To investigate whether a 2-year MRI treat-to-target strategy targeting the absence of osteitis combined with clinical remission, compared with a conventional treat-to-target strategy targeting clinical remission only (IMAGINE-rheumatoid arthritis (RA) trial) improves clinical and radiographic outcomes over 5 years in patients with RA in clinical remission.
Methods IMAGINE-more was an observational extension study of the original 2-year IMAGINE-RA randomised trial (NCT01656278). Clinical examinations and radiographs (hands and feet) were obtained yearly. Prespecified coprimary outcomes at year 5 were Disease Activity Score in 28 joints C reactive protein (DAS28-CRP) remission rate (DAS28-CRP<2.6) and no radiographic progression (van der Heijde-modified Sharp score (vdHSS) ≤0) from baseline. Secondary outcomes included 5-year changes in radiographic, MRI and clinical measures of disease activity and physical function.
Results In total 131 patients, 86 women (67%), mean age 61.2, disease duration 9.5 years, median baseline DAS28-CRP 1.9 (IQR 1.6–2.2) and vdHSS 16.0 (IQR 7.0–36.0) were included in the study; 59 (59%) patients from the original MRI treat-to-target group and 72 (72%) from the conventional group. At year 5, 47 patients (80%) in the MRI treat-to-target group vs 54 patients (75%) in the conventional treat-to-target group were in DAS28-CRP remission (OR 2.00 (95% CI 0.76 to 5.28); p=0.16) while 14 patients (24%) vs 19 patients (26%) had no radiographic progression (OR 0.70, (95% CI 0.28 to 1.71); p=0.43).
Conclusion A 2-year combined MRI and clinical treat-to-target strategy, compared with a conventional clinical treat-to-target strategy alone, had no effect on the long-term probability of achieving DAS28-CRP remission and of avoiding radiographic progression.
- Inflammation
- Magnetic Resonance Imaging
- Patient Reported Outcome Measures
- Arthritis, Rheumatoid
Data availability statement
No data are available.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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WHAT IS ALREADY KNOWN ON THIS TOPIC
Short-term clinical and radiographic outcomes are not improved by targeting MRI remission in combination with clinical remission compared with a clinical treat-to-target strategy alone in patients with rheumatoid arthritis (RA).
It is unknown if there is a long-term beneficial effect.
WHAT THIS STUDY ADDS
The IMAGINE-more study is the first study to investigate the long-term impact of a systematic 2-year MRI-guided treat-to-target strategy on clinical and radiographic outcomes. Neither improved remission rates nor reduced radiographic progression over 5 years were found.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
This study supports current clinical recommendations for the management of RA and does not support the systematic use of MRI to guide treatment in patients with RA in clinical remission to further improve clinical and radiographic outcomes.
Introduction
Modern management of rheumatoid arthritis (RA) should be based on targeted treatment strategies aiming for sustained remission or low disease activity in every patient.1 Nevertheless, progression in structural joint damage is still frequent, despite the patients fulfilling the recommended remission criteria, and is associated with functional impairment and reduced quality of life.2–4 Inflammation assessed on MRI, in particular osteitis, has shown to be a strong predictor of subsequent bone damage progression in patients with active RA and in patients in remission.5–9 However, targeting MRI remission in patients in clinical remission by adding an MRI treat-to-target strategy to a clinical treat-to-target strategy for 2 years did not improve clinical and radiographic outcomes in the short term compared with a clinical treatment strategy targeting clinical remission alone.10 It has not been investigated if there is a long-term beneficial effect. The purpose of the IMAGINE-more study was, therefore, to investigate whether a 2-year MRI treat-to-target strategy targeting the absence of osteitis combined with clinical remission, compared with a conventional clinical treat-target strategy targeting clinical remission only, improves disease activity and reduces radiographic progression over 5 years in patients with RA in clinical remission.
Methods
Study design
The IMAGINE-more study was designed as a long-term observational extension study (with scheduled visits 3, 4, 5 and 10 years after randomisation) of the 2-year IMAGINE-RA randomised, Danish, multicentre clinical trial and added as a protocol amendment to the IMAGINE-RA protocol.11 Eight of the original nine IMAGINE-RA centres participated in the IMAGINE-more follow-up study (the hospital not participating had originally five patients included in the IMAGINE-RA study and four of these completed study). The results reported here are based on data collected at years 3, 4 and 5 from the patient’s baseline visit in the IMAGINE-RA trial.
The design and outcomes of the IMAGINE-RA randomised trial have previously been published and are therefore only briefly described below.10 The IMAGINE-RA included 200 patients with RA in clinical remission (Disease Activity Score in 28 joints C reactive protein (DAS28-CRP)<3.2 and no swollen joints) who were anticyclic citrullinated peptide (CCP) positive, had erosive disease (bone erosion on conventional radiography), were bionaive and received conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). IMAGINE-RA investigated whether an MRI treat-to-target strategy targeting the absence of osteitis in combination with clinical remission (DAS28-CRP≤3.2 and no swollen joints) could increase remission rates and prevent erosive progression compared with a conventional treat-to-target strategy targeting clinical remission only. If the treatment target was not met, treatment was escalated every 4 months according to a predefined treatment algorithm starting with increment in csDMARDs and subsequently, if the target was still not met, by adding a biological DMARD (bDMARD).
Participants
Patients participating in IMAGINE-RA were before study termination invited to participate in the IMAGINE-more extension study and written informed consent was obtained. The first patient was included March 2015.
Assessments
After study termination in IMAGINE-RA, the patients were managed in the routine outpatient clinic applying a conventional treatment strategy targeting clinical remission according to routine Danish practice targeting DAS28-CRP≤3.2 and no swollen joints including the use of intra-articular glucocorticoids in clinically swollen joints to maintain strict inflammation suppression. Treatment decisions were based on the evaluation of the patient’s treating physician and were not obliged to follow the predefined treatment algorithm. In addition, protocolised clinical IMAGINE-more visits were carried out by the IMAGINE-RA site investigators at years 3, 4 and 5 after the patients IMAGINE-RA baseline visit. Visits were allowed to be carried out up to 8 weeks before and after the protocolised visit dates and imaging up to 4 weeks before and after the patients had been to the visit. The visits included the same clinical and imaging evaluation as performed in the IMAGINE-RA trial, for example, the measurement of clinical disease activity measures including DAS28-CRP, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI) and radiographs of hands (posteroanterior view) and feet (anteroposterior view). Contrast-enhanced MRIs of the dominant hand including the second to fifth metacarpophalangeal joints were done at years 3 and 5, applying the Outcome Measures in Rheumatology RA MRI scoring system (OMERACT RAMRIS).12 The results of the MRIs were not available to the treating physician or the investigator. Evaluation was performed centrally by two experienced readers in the evaluation according to the van der Heijde-modified Sharp score (vdHSS) for evaluation of radiographs (LMØ) and the RAMRIS scoring method for evaluation of MRI scans (DG), which were the same readers who evaluated the radiographs and MRI scans in the IMAGINE-RA study.12 13 Images were evaluated in chronological order (four sets of radiographs and three sets of MRI scans) using the last IMAGINE-RA visit (year 2) as baseline, with the evaluators blinded to all clinical, laboratory and other image data.14 Changes from baseline to 5 years in vdHSS erosion score and MRI scores were the sum score of the calculated change from baseline to year 2 (the original score form the IMAGINE-RA trial) and changes from year 2 to year 5 with the scores given to the original year 2 examination known to the reader.
Treatment
At the time of inclusion, the patients received different antirheumatic drug treatments in the form of cs and/or bDMARDS depending on the algorithmic treatment escalations previously performed in IMAGINE-RA. Further treatment in IMAGINE-more was decided by the treating rheumatologist according to local guidelines, still with the treatment goal aiming at optimal clinical disease control in the form of DAS28 remission.
Patient and public involvement
Patients or the public were not involved in the design and conduct of the study nor in the reporting or dissemination plans.
Outcomes
Primary outcomes
The two coprimary outcomes were assessed at 5 years from baseline (ie, 3 years after study termination of the IMAGINE-RA randomised trial). The primary clinical outcome was the proportion of patients in DAS28-CRP remission (DAS28-CRP<2.6) at year 5 and the primary radiographic outcome was the proportion of patients with no radiographic progression according to the vdHSS scoring system (progression defined as change in total vdHSS score >0) from baseline to 5 years.
Secondary outcomes
Predefined key secondary outcomes were disease activity (DAS28-CRP), change in total vdHSS, change in MRI osteitis (OMERACT RAMRIS) score and change in functional level (Health Assessment Questionnaire, HAQ) from baseline to 5 years follow-up.
Additional secondary outcomes all assessed at 5 years were as follows: remission according to ACR/EULAR 2011 criteria, SDAI remission (SDAI≤3.3), CDAI remission (CDAI≤2.8), tender joint count (0–28), swollen joint count (0–28), patient Visual Analogue Scale (VAS) global, patient VAS pain, patient VAS fatigue and investigator VAS global. In addition, changes from baseline to 5 years in vdHSS erosion score, joint space narrowing (JSN) score, RAMRIS MRI synovitis, tenosynovitis, erosion, JSN, combined inflammation (sum score of MRI synovitis, osteitis and tenosynovitis) and MRI combined damage (sum score of MRI erosion, JSN) score and no progression in MRI erosions score from baseline to 5 years (RAMRIS erosion score <1) were evaluated. Finally, the percentage of patient categorised as having a normal function (HAQ≤0.5) at year 5 and changes in 36-Item Short Form score physical and mental component scores (measuring physical health and mental well-being) and in Disease Activity Score in 28 joints C reactive protein score from baseline to 5 years follow-up and the proportion of patients in cs/bDMARD/no treatment at year 5 was measured.
Statistical procedures
The coprimary and secondary outcomes were analysed based on the intention-to-treat (ITT) principle: The modified ITT (mITT) population aimed to explore the sustained effect of being in the IMAGINE-RA trial from year 2 and beyond. All patients who completed the first 2-year period in IMAGINE-RA, gave informed consent to participate in IMAGINE-more and received at least the baseline assessment (in IMAGINE-more) were included in the analyses and analysed according to their allocated treatment strategy (MRI-guided treat-to-target treatment strategy or a conventional DAS28-CRP-guided treat-to-target treatment strategy) in the IMAGINE-RA trial (independent of adherence to the IMAGINE-RA or the IMAGINE-more protocol).
For dichotomous outcomes assessed after 5 years, ORs with 95% CIs were estimated from logistic regression models including a fixed factor for the original treatment arm, and an adjustment via the propensity score (based on pre-exposure covariates). For continuous outcomes, estimates were based on repeated measures mixed effects linear models, with fixed factors for the original treatment arm and time point (nine levels for disease activity measures and five levels for the radiographic outcomes), and the corresponding interaction (time×group), adjusted for the value at baseline and the propensity score corresponding to the (remaining in) original group allocation.
The propensity score adjustment: The primary goal was to adjust for potential confounding variables in the mITT population making the groups comparable with respect to covariates and thereby more likely that any differences observed in the outcomes could be causally attributed to the treatment rather than confounding variables. Propensity scores for each participant were derived from logistic regression models applying single median imputation for missing covariate data. The computation of the propensity scores was based on all baseline variables in the analysis data set (prerandomisation in IMAGINE-RA (ie, not influenced by post hoc elements)). This approach was chosen since in a small sample size it has been suggested that using this method including all measured baseline characteristics is an acceptable approach.15 16 To assess the performance of the model, we assessed the balance of propensity scores across the two treatment groups.
For the continuous outcomes, missing data in the mITT population were handled indirectly with the repeated-measures mixed effects models as the primary analysis approach (based on all usable data, and no manual imputation), that is, considered valid assuming that data were ‘missing at random’.17 For binary outcomes, a simple non-responder imputation was used for the primary analyses (ie, if missing after 5 years, the patient did not achieve remission).
For sensitivity, the coprimary dichotomous outcomes (binary data), ‘worst-case’, ‘best-case’, as well as ‘worst-best-case’, and ‘best-worst-case’ imputations were also carried out. The smallest detectable change for total vdHSS was calculated to show the degree of progression that could be reliable detected above the measurement error.18 Furthermore, post hoc, we analysed the primary outcomes without any propensity score adjustment as well as stratified by centre. The analyses were performed by using SAS tudio (Release: 3.8; SAS Institute Inc., Cary, NC, USA) and R V.4.0.3; For R, the package nlme was applied.19
Results
Patient characteristics
Between May 2014 (time of approval of the IMAGINE-more protocol amendment) and April 2017 (last patient last visit in IMAGINE-RA), patients were asked to participate in the extension study. Totally, 131 patients gave informed consent and were included in the primary analyses (59 in the MRI treat-to-target group and 72 in the conventional treat-to-target group). The last patient last visit (year 5) took place in August 2020. 55 patients in the MRI treat-to-target group and 66 patients in the conventional treat-to-target group completed the 5-year follow-up (figure 1). Demographic and clinical baseline characteristics of participants in the IMAGINE-more study are presented in table 1.
Trial profile (patient flow diagram).*Details regarding patients disposition after randomisation in the IMAGINE-RA trial are previously described in Møller-Bisgaard et al JAMA 2019 (Møller-Bisgaard S, Hørslev-Petersen K, Ejbjerg B, et al. Effect of magnetic resonance imaging vs conventional treat-to-target strategies on disease activity remission and radiographic progression in rheumatoid arthritis: the IMAGINE-RA randomized clinical trial. JAMA 2019;321:461–72. 10.1001/jama.2018.21362).
Demographic, clinical and imaging baseline characteristics of participants in the IMAGINE-more study
Coprimary outcomes
At year 5, 47 of 59 patients (80 %) in the MRI treat-to-target group vs 54 of 72 (75%) in the conventional treat-to-target group were in DAS 28-CRP remission (OR 2.00 (95% CI 0.76 to 5.28); p=0.16) and 14 of 59 patients (24%) vs 19 of 72 patients (26%) had no radiographic progression since baseline (OR 0.70 (95% CI 0.28 to 1.71); p=0.43) (table 2). Structural damage progression above the smallest detectable change (2.2) occurred in 33 patients (32%) (13 patients (28%) in the MRI treat-to-target group and 20 patients in the conventional treat-to-target group (36%), with no statistically significant difference between the groups).
Primary, key secondary and other secondary outcomes at 5 years
Secondary outcomes
Among the four key secondary outcomes assessed at year 5, there were no differences between the treatment groups (table 2). Of the other secondary outcomes, most were not different between the two groups. Only one outcome significantly improved more in the original MRI treat-to-target group compared with the conventional treat-to-target group. This was patient VAS pain (difference between groups: least squares mean, −7.0 (95% CI −12.8 to −1.2); p=0.018). Also, patients in the MRI treat-to-target group also tended to have a lower VAS global (−5.9 (95% CI −11.9 to 0.0); p=0.051). More patients in the MRI-treat-to-target group received biological treatment, 22 patients (37%) in the MRI treat-to-target group vs 6 (8%) in the conventional treat-to-target group (OR 4.80 (95% CI 1.66 to 13.86); p=0.004).
Sensitivity analyses
Sensitivity analyses for the primary outcomes included multiple imputation, worst-case and best-case scenario imputations (online supplemental etable 1). When missing data were imputed according to worst-best case, there was a higher rate in the conventional treat-to target group who had no radiographic progression compared with the MRI treat-to target group. Imputing the missing data according to best-worst-case imputation, there was a higher rate of DAS-28 CRP remission in the MRI treat-to target group compared with the conventional treat-to-target group.
Supplemental material
Post hoc analyses
Post hoc analyses with no adjustment for propensity score showed similar results (online supplemental etable 2). The distributions of propensity scores for the two treatment groups differed slightly, but there was a large overlap in the range of propensity scores between them (online supplemental efigure 1). We found no statistically significant interaction of centre on primary or secondary outcomes at 5 years (online supplemental etable 3).
Discussion
This is the first study assessing the long-term efficacy of targeting MRI inflammation in patients with RA. The remission rates and radiographic progression over 5 years of a 2-year MRI treat-to-target strategy compared with a conventional clinical treat-to-target approach were similar.
The primary results from this long term study are consistent with the 2-year findings from the IMAGINE-RA randomised clinical trial.10 DAS28-CRP remission rates remained high after 5 years. However, a small decrease in remission rates from 2 to 5 years was observed, with no statistically significant differences between the groups (80% of patients in the MRI-treat-to-target group vs 75% in the conventional treat-to-target group were in DAS28-CRP remission after 5 years compared with 85% and 88%, respectively, after 2 years).
One explanation for the decrease in remission rates may be that the patients were followed less rigorously with longer intervals between visits compared with the 4 months visits in IMAGINE-RA trial, and that the physician was not obliged to follow the predefined treatment algorithm as done in the IMAGINE-RA trial. An explanation for the remission rates, however, still maintained high may be that, in addition to the applied conventional treatment strategy targeting clinical remission both groups were treated by intra-articular glucocorticoids in all swollen joints.20 This was done not only during the first 2 years but also in the follow-up period since this is part of Danish clinical practice.
Remission rates reported in studies which have systematically used intra-articular glucocorticoids and csDMARDs as part of a clinical treat-to-target strategy differ in the short term but in the long term they are comparable to the remission rates found in the current study. The treatment strategy in the CIMESTRA trial was very similar to the clinical treat-to-target strategy used in IMAGINE-RA.21 Patients with early, treatment-naïve RA were at baseline randomised to receive ciclosporine or placebo ciclosporine in combination with methotrexate and followed a step-up treatment algorithm with cs/bDMARDs in case of disease activity combined with intra-articular glucocorticoid in case of clinically swollen joints.21 After 2 years, half of the patients were in DAS28-remission with no statistically differences between the groups.22 These remission rates are lower compared with the remission rates at 2 years in our study (85%–88%). However, at year 5, the remission rates were comparable, where 78% of the patients had reached DAS28-CRP remission, with no difference between the treatment groups. In the OPERA trial, the patients were initially randomised to receive adalimumab or placebo adalimumab in combination with methotrexate and intra-articular glucocorticoids.23 The DAS28remission rates after 24 months showed no difference between the treatment groups (69% in the methotrexate+placebo group vs 66% in the methotrexate+adalimumab group).24 The lower remission rates at 2 years reported in the two above-mentioned studies may be explained by the patients being early RA (<6 months), patients with active disease compared with patients in the IMAGINE studies who had established RA and were in clinical remission at inclusion. In line with the study by Hetland et al and current international recommendations for the management of RA, the results of our study support that a strict clinical treat-to-target strategy, irrespective of what DMARDs used, in combination with intra-articular injections, leads to excellent disease control at 5 years with no added effect of systematic monitoring by MRI.1 7
No previous study has evaluated an imaging treat-to-target strategy targeting MRI inflammation. Two randomised clinical trials investigating an ultrasound treat-to-target strategy in patients with early RA, with the treatment goal of absence of synovitis by ultrasonography, the ARCTIC trial and the TASER trial, did not show significant improvement in clinical or radiographic outcomes compared with clinical treat-to-target strategies.25 26 These results are consistent with findings reported here. However, follow-up periods were only 24 and 18 months, respectively.
In the current study, approximately 75% of patients in both treatment groups had radiographic damage progression from baseline over the 5-year period with no statistically significant differences between the treatment groups, when progression was defined as an increase in vdHSS>0. Of these, 33 (32%) had structural damage progression above the smallest detectable change. In a study by Lillegraven et al investigating radiographic damage progression in a cohort of 535 patients in remission, damage progression occurred in 30% of patients in DAS28-CRP remission after 2 years, comparable to the observed progression observed in this study after 5 years.2 In the study by Hetland et al, the 5-year radiographic progression rate was 53%.7 One explanation for a higher progression rate in our study compared with the progression rates observed in the study by Hetland et al may be that the patients had more established disease with a disease duration of approximately 10 years vs less than 4 months and a higher total vdHSS at baseline (median vdHSS 19.5 (IQR 10.0–39.8) in the MRI treat-to-target group and 14.0 (7.0–36.0) in the conventional treat-to-target group versus median vdHSS 3 (IQR 0–7) in the methotrexate plus placebo-ciclosporin group and 2 (0–8) in the methotrexate plus ciclosporin group in the CIMESTRA study. In addition, all patients had poor prognostic factors for radiographic progression (anti-CCP positivity and erosive disease on conventional radiographs at baseline). Also, the radiographs were read in chronological order which result in a higher sensitivity to change.14
At year 2 (closure of the IMAGINE-RA study), seven predefined secondary outcomes favoured the MRI treat-to-target group compared with the conventional treat-to-target group.10 However, these previously observed differences at year 2 in physical function (HAQ score), MRI inflammation (osteitis, tenosynovitis and MRI combined inflammation score), patient-reported outcomes (patient VAS global), investigator’s global assessment of disease activity and swollen joint count were no longer present after 5 years. At year 5, a better improvement from baseline in VAS pain was observed in the MRI treat-to-target group compared with the conventional treat-to-target group (borderline significant at year 2). A probable explanation for the lack of difference in these outcomes at year 5 is that the treatment in the years 2–5 extension was similar in the two treatment groups as patients were followed in the routine outpatient clinic applying a conventional treatment strategy targeting clinical remission. In addition, only 131 of 200 patients participated in the extension study which may have resulted in lack of statistical power to detect a difference. Further, the secondary outcomes were not adjusted for multiple testing and should, therefore, be interpreted with caution.
At 2 years, 46% in the MRI treat-to-target group vs 2% in the conventional treat-to-target group received biological treatment. At 5 years follow, the number of patients in the MRI treat-to-target group who received biological treatment was still high compared with the conventional treat-to-target group (37% vs 8%.). Despite more patients in the MRI treat-to-target group received biological treatment, no effect was observed on achieving DAS-CRP remission or on radiographic progression. This may suggest that in some patients in the MRI treat-to-target group the treatment with bDMARDs could have been unnecessary, with a risk of adverse events without effect on clinical or radiographic outcomes.
The study has strengths and limitations. A weakness is the observational design of the extension study, which may have created bias/confounding. We tried to improve the confounding variable balance between the two groups by matching observations from each group (at the 2-year sampling) based on the propensity score. The small sample size may have resulted in lack of statistical power to detect a difference. Only 59% of the patients originally randomised to the MRI treat-to target strategy and 72% of the patients originally randomised to the conventional treat-to-target strategy participated in the follow-up study, which could cause selection bias. However, no differences in baseline characteristics of the patients participating in the IMAGINE-more study compared with the patients not included were observed within the randomised groups (online supplemental etable 4). In addition, the propensity score aimed to account for selection bias. Also, the small sample size, drop-outs and the fact that one hospital did not participate in the follow-up study may have skewed the distribution of the patients across the different hospitals and influenced the results. However, the hospital not participating had originally only five patients included in the IMAGINE-RA study and only four completed the study and there were no site-related effects on primary outcomes at 5 years when stratified by centre (online supplemental etable 3).
The patients were managed in routine outpatient clinic and treated by the local physician, while the IMAGINE-more visits were carried out by the IMAGINE-RA site investigator. At some sites, the patient’s treating physician also was the site investigator, which may have led to bias due to the non-blinded design of the study.
A strength is the long follow-up period where only 10 patients from 2 to 5 years discontinued the extension study.
In conclusion, among patients in remission, a 2-year combined MRI treat-to-target and clinical treat-to-target strategy as compared with a conventional clinical treat-to-target strategy alone, had no effect on remission rates and radiographic progression over 5 years. In accordance with the primary results from the IMAGINE-RA trial, these long-term data do not support systematic use of MRI to guide treatment in patients with RA in remission.
Data availability statement
No data are available.
Ethics statements
Patient consent for publication
Ethics approval
Prior to implementation the protocol was approved by the Regional Committees on Health Research Ethics (19 May 2014, ID S-20110109) and carried out in compliance with the Declaration of Helsinki and the International Conference on Harmonisation Guidelines for Good Clinical Practice. All patients gave written informed consent.
Acknowledgments
The authors thank the patients who participated in the IMAGINE-more study. Abstracts on the data in the present report were presented at the Annual European Congress of Rheumatology (EULAR), 2022 http://scientific.sparx-ip.net/archiveeular/searchforsigneview1caitem and 2023 http://scientific.sparx-ip.net/archiveeular/?view=1&c=a&searchfor=signe&item=2023POS0052) and at the annual scientific meeting of the American College of Rheumatology (ACR) 2022 https://acrabstracts.org/abstract/long-term-efficacy-of-a-2-year-mri-treat-to-target-treatment-strategy-on-disease-activity-mri-inflammation-and-physical-function-in-rheumatoid-arthritis-patients-in-clinical-remission-five-year-foll and 2023 https://acrabstracts.org/abstract/long-term-efficacy-of-a-2-year-mri-treat-to-target-strategy-on-radiographic-joint-damage-progression-in-rheumatoid-arthritis-patients-in-clinical-remission-five-year-follow-up-of-the-imagine
References
Supplementary materials
Supplementary Data
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Footnotes
Contributors SM-B, KH-P, MLH and MO contributed to the conception and design of the study. SM-B, KH-P, LMØ, BE, MLH, JMM, SMN, DG, MB, KS-P, ORM, EH, OH, JAV, HL, AGJ, HT and MO contributed the acquisition of data. RC, SMN and NSK contributed to the statistical analyses of data and all the authors critically interpreted and analysed on the results. SM-B wrote the draft of the manuscript, and all the authors critically revised the manuscript for important intellectual content and approved the final version. SM-B had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. SM-B is the guarantor for this paper.
Funding The IMAGINE-RA study was supported by AbbVie. The IMAGINE-more study was supported by the Danish Rheumatism Association. The Parker Institute, Bispebjerg and Frederiksberg Hospital (RC and SMN) is supported by a core grant from the Oak Foundation (OCAY-18-774-OFIL).
Competing interests SMB has received research support from AbbVie and support for attending meetings and/or travl from Medac and Novartis. KHP has received research support from AbbVie. LMØ has received research grant from Novartis. MLH has received research grant from AbbVie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Foundation, MSD, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis, Nordforsk and speaking fees and/or honoraria from Pfizer, Medac, Sandoz paid to institution and has chaired the steering committee of the Danish Rheumatology Quality Registry (DANBIO, DRQ), which receives public funding from the hospital owners and funding from pharmaceutical companies. MLH co-chairs EuroSpA, which generates real-world evidence of treatment of psoriatic arthritis and axial spondylorthritis based on secondary data and is partly funded by Novartis. DG has received consulting fees from Janssen and speaking fees from Eli Lilly and Advisory board activity for AbbVie and Eli Lilly. MB has received research support from AbbVie and speaking fees from AbbVie, UCB, Eli Lilly, Image Analysis Group, Esaote. EMH has received research grants from Independent Research Fund Denmark, Novo Nordic Foundation, Danish Rheumatism Association, Aarhus University, Danish Regions Medicine Grants, Galapagos, AbbVie, Roche, Novartis, consulting fees from Novo Nordic, Novartis, AbbVie, Sanofi, Sobi, MSD, UCB, spekin fees from Novo Nordic, Novartis, AbbVie, Sanofi, Sobi, MSD, UCB, support for attending meetings and/or travl from Pfizer Sobi, AbbVie, Celgene, MSD, Roche, advisory board SynACT Pharma and principal trial investigator/site investigator for trials supported by AbbVie, Novartis, Novo Nordic, Sanofi, SynACT Pharma. OH has received speaking fees from Abbvie, Pfizer, Novartis, Eli-Lilly and support for attending meetings and/or travl from Pfizer, Abbvie. NSK has received grants from ScandRA and EuroStar. MØ has received research support 15 from AbbVie and grants from Amgen, BMS, Merck, Celgene and Novartis, Galapagos, Gilead, Hospira, Janssen, Merck, Novartis, Pfizer, UCB and consulting fees from Abbvie, BMS, Eli-Lilly, Galapagos, Gilead, Janssen, Merck, Novartis, Pfizer, UCB, speaking fees from Abbvie, BMS, EliLilly, Galapagos, Gilead, Janssen, Merck, Novartis, Pfizer, UCB. BE, JM, SMN, KSP, ORM, BJ, JAV, HL, AGJ, HST, RC, have nothing to disclose.
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