OP0199 Sustained remission of inflammation is associated with reduced structural damage on sacroiliac joint magnetic resonance imaging in patients with early axial spondyloarthritis: evidence to support the concept of treat-to-target
Authors: W.P. Maksymowych, P. Claudepierre, M. de Hooge, R.G. Lambert, R. Landewé, A. Molto, D. van der Heijde, J.F. Bukowski, H. Jones, I. Logeart, L. Marshall, R. Pedersen, A. Szumski, B. Vlahos, M. Dougados
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Treat-to-target is acceptable in RA; however, it is unknown whether it will reduce/prevent disability, impairment of mobility, and structural damage in early axial spondyloarthritis (axSpA) without radiographic sacroiliitis. <h3>Objectives</h3> To evaluate the impact of sustained clinical remission on MRI structural parameters. We hypothesised that patients with sustained inactive disease according to the ankylosing spondylitis disease activity score (ASDAS &lt;1.3) are more likely to achieve reduction in erosion (structural damage) and increase in backfill (a reparative process) on MRI of the SI joints (SIJ). <h3>Methods</h3> EMBARK (NCT01258738) and DESIR (NCT01648907) enrolled patients with early axSpA. EMBARK included 12 weeks of double-blind placebo-control, then open-label etanercept for 92 weeks. Patients in the DESIR observational cohort had no history of biologics and received no biologics for 2 years. T1 weighted MRI images of SIJ at baseline and 104 weeks were combined and anonymized; readers were unaware of film chronology and original patient cohort. Three experienced readers evaluated MRI images using the SpondyloArthritis Research Consortium of Canada SIJ Structural Score. Lesion change was considered present if ≥2 of 3 readers measured change in same direction. ASDAS endpoints were assessed sequentially: sustained (≥2 visits 6 months apart) inactive disease (ASDAS &lt;1.3) or moderate disease activity (≥1.3 to&lt;2.1); or no sustained response (≥2.1). Net proportions of patients with decrease in erosion and increase in backfill were determined, unadjusted and adjusted for covariates that may affect development of lesions on MRI. <h3>Results</h3> From EMBARK and DESIR, 161 and 76 patients, respectively, were included. For patients in EMBARK with sustained ASDAS &lt;1.3, a greater percentage had decrease in erosion (34/104, 32.7%) than increase (5/104, 4.8%); p&lt;0.0001; without sustained response, 5/24 (20.8%) had decrease in erosion and 1/24 (4.2%) had increase. This trend was also present in DESIR. Patients with sustained ASDAS &lt;1.3 in EMBARK: 22.1% had increase in backfill, 0% had decrease; p&lt;0.0001; in DESIR, 21.7% had increase, 0% had decrease; p&lt;0.05. For those without sustained response, difference between increase and decrease was smaller. Net percent of patients (adjusted) with sustained ASDAS &lt;1.3 and erosion decrease: 22.6% and 9.3% for EMBARK and DESIR, respectively; without sustained response: 13.3% and −10.1%. Net percent of patients with sustained ASDAS &lt;1.3 and backfill increase: 19.6% and 25.7% for EMBARK and DESIR, respectively; without sustained response: 8.7% and 6.0%. <h3>Conclusions</h3> These data demonstrate a link between sustained ASDAS inactive disease and MRI structural endpoints. Clinical relevance of change in MRI SIJ erosion and backfill and their relationship to ankylosis development requires study. <h3>Disclosure of Interest</h3> W. Maksymowych Grant/research support from: AbbVie, Pfizer, Consultant for: Abbvie, Janssen, Lilly, Merck, Novartis, Pfizer, UCB, P. Claudepierre Consultant for: Abbvie, BMS, Celgene, Janssen, Novartis, Merck, Pfizer, Roche, UCB, Lilly, M. de Hooge Employee of: Selfemployed without other personnel (registered company under the Belgium law) MdH Research. Additional Affiliation: Ghent University, Ghent, Belgium., R. Lambert Consultant for: AbbVie, Bioclinica, Janssen, Parexel, UCB, R. Landewé Grant/research support from: Abbott, Amgen, Centocor, Novartis, Pfizer, Roche, Schering-Plough, UCB, Consultant for: AbbVie, Ablynx, Amgen, Astra-Zeneca, Bristol Myers Squibb, Celgene, Janssen, Galapagos, GlaxoSmithKline, Novartis, Novo-Nordisk, Merck, Pfizer, Roche, Schering-Plough, TiGenix, UCB, Employee of: Director of Rheumatology Consultancy BV, which is a registered company under Dutch law, Speakers bureau: Abbott/AbbVie, Amgen, Bristol Myers Squibb, Janssen, Merck, Pfizer, Roche, Schering-Plough, UCB, A. Molto Grant/research support from: Pfizer, Consultant for: Merck,UCB, D. van der Heijde Consultant for: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Daiichi, Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB, Employee of: Director of Imaging Rheumatology bv., J. Bukowski Shareholder of: Pfizer, Employee of: Pfizer, H. Jones Shareholder of: Pfizer, Employee of: Pfizer, I. Logeart Shareholder of: Pfizer, Employee of: Pfizer, L. Marshall Shareholder of: Pfizer, Employee of: Pfizer, R. Pedersen Shareholder of: Pfizer, Employee of: Pfizer, A. Szumski Employee of: InVentiv Health, B. Vlahos Shareholder of: Pfizer, Employee of: Pfizer, M. Dougados Grant/research support from: Pfizer, AbbVie, UCB, Merck, Lilly, Consultant for: Pfizer, AbbVie, UCB, Merck, Lilly