FRI0044 Exceeding predefined thresholds for mri bone oedema and erosion and haq-di can predict relapse after withdrawal of all treatment in mtx-naÏve patients with ra in remission after 12 months of abatacept therapy in the avert trial
Authors: H.A. Ahmad, J.F. Baker, M. Østergaard, P. Emery, T. Huizinga, Y. Elbez, S. Banerjee, P.G. Conaghan
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> To assist in clinical decision making it is important to understand the factors, and their thresholds, that might predict relapse following treatment withdrawal in patients with RA in remission. In a previous <i>post hoc</i> analysis of the AVERT trial (NCT01142726), in which several potential factors were assessed, erosions, synovitis and bone oedema scores on MRI and HAQ-DI scores in patients with DAS28 (CRP) &lt;2.6 were associated with clinical relapse 6 and 12 months after complete drug withdrawal following 12 months of blinded treatment with abatacept +MTX or abatacept or MTX alone.<sup>1,2</sup> Knowledge of the thresholds for these measures, above which relapse is more likely to occur, may aid clinical decisions about when to withdraw treatment in patients who have achieved remission. <h3>Objectives</h3> To evaluate <i>post hoc</i> the association between different thresholds of MRI and HAQ-DI scores at Month 12 and the risk of relapse at Months 18 and 24 in AVERT. <h3>Methods</h3> This analysis compared relapse event rates at Months 18 and 24 in patients with DAS28 (CRP) &lt;2.6 but with differing severities of synovitis, bone oedema and erosion (assessed by MRI individual and combined scores) and HAQ-DI scores at Month 12. A relapse event was defined by the doubling of TJC28 and SJC28 and an increase in DAS28 (CRP) ≥1.2 relative to the Month 12 visit. Synovitis, bone oedema and erosion in the dominant hand and wrist MRI were scored using the OMERACT RAMRIS. Severity of each score was defined by cut-offs of &gt;3 for synovitis,&gt;2 for bone oedema,&gt;7 for (weighted) combined synovitis and bone oedema,&gt;5 for erosion and &gt;0.5 for HAQ-DI. Univariate logistic models were conducted for comparisons and odds ratios (OR) with 95% CI and associated p values. <h3>Results</h3> All randomised and treated patients with DAS28 (CRP) &lt;2.6 at Month 12 and relapse status available at Months 18 and 24 (n=155) were included. Among the overall study cohort at Month 12, 70 (45.2%) patients with DAS28 (CRP) &lt;2.6 had a higher synovitis score (&gt;3), 28 (18.1%) had a higher bone oedema score (&gt;2), 39 (25.2%) had a higher combined score (&gt;7), 73 (47.1%) had a higher erosion score (&gt;5) and 42 (27.1%) had a higher HAQ-DI score (&gt;0.5). Relapse events at Months 18 and 24 were significantly associated with supra-threshold MRI bone oedema, erosion and combined scores and with supra-threshold HAQ-DI score at Month 12 (figure 1). There was a trend toward association of relapse at Months 18 and 24 with high synovitis score (figure 1). <h3>Conclusions</h3> It was possible to define MRI and HAQ-DI scores in patients with DAS28 (CRP) remission that were predictive of relapse 6 and 12 months after complete drug withdrawal in AVERT. Assessment of imaging and physical function, using predefined thresholds, in patients achieving remission may aid clinical decisions on when to withdraw therapy in MTX-naïve patients with RA. <h3>References</h3> [1] Emery P, et al. Ann Rheum Dis2015;74:19–26. [2] Ahmad H, et al. Ann Rheum Dis2017;76(suppl 2):240. <h3>Disclosure of Interest</h3> H. Ahmad Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, J. Baker: None declared, M. Østergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Janssen, Merck, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Centocor, GSK, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Schering-Plough, Roche, Takeda, UCB, Wyeth, P. Emery Consultant for: AbbVie, Bristol-Myers Squibb, Merck, Pfizer, Roche, Lilly, Novartis, Samsung Bioepis, T. Huizinga Grant/research support from: EU and Dutch Arthritis Foundation, Consultant for: Abbott Laboratories, Biotest AG, Bristol-Myers Squibb, Crescendo Bioscience, Novartis, Pfizer, Roche, sanofi-aventis, Schering-Plough, UCB, Eli Lilly, Speakers bureau: Abbott Laboratories, Biotest AG, Bristol-Myers Squibb, Novartis Pharmaceuticals Corporation, Pfizer Inc, Roche, sanofi-aventis, Schering-Plough, Y. Elbez Consultant for: Bristol-Myers Squibb, S. Banerjee Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, P. Conaghan Grant/research support from: Bristol-Myers Squibb, Consultant for: AbbVie, GSK, Lilly, Novartis, Pfizer, Roche, Speakers bureau: AbbVie, Bristol-Myers Squibb, Novartis