Delayed Gadolinium-enhanced MR Imaging of Cartilage - A Pilot Study to Measure the Effect of Adalimumab Plus MTX versus Placebo Plus MTX on Cartilage in Early RA Patients (CAR-ERA-Study)

Philipp Sewerin¹, Miriam Frenken ², Ralph Brinks ³, Christoph Schleich ², Daniel Benjamin Abrar ², Stefan Vordenbaeumen ⁴, Ruben Sengewein ⁵, Jutta Richter ⁶, Matthias Schneider ⁷ and Benedikt Ostendorf ⁴, ¹Department of Rheumatology & Hiller Research Unit, University Hospital Düsseldorf,, Duesseldorf, Germany, ²Institute for Diagnostic and Interventional Radiology, UKD, Heinrich Heine University, Duesseldorf, Germany, ³Policlinic for Rheumatology & Hiller Research Centre for Rheumatology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany, ⁴Policlinic and Hiller Research Unit of Rheumatology, UKD, Heinrich Heine University, Duesseldorf, Germany, ⁵Policlinic and Hiller Research Unit of Rheumatology,, Duesseldorf, Germany, ⁶Department and Hiller Research Unit of Rheumatology, Heinrich-Heine University Duesseldorf, Duesseldorf, Nordrhein-Westfalen, Germany, ⁷Policlinic for Rheumatology & Hiller Research Centre for Rheumatology, Heinrich-Heine-University Duesseldorf, Düsseldorf, Germany

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Early Rheumatoid Arthritis and cartilage, Magnetic resonance imaging (MRI)

Session Information

Date: Monday, November 11, 2019

Title: Imaging Of Rheumatic Diseases Poster II

Session Type: Poster Session (Monday)

Session Time: 9:00AM-11:00AM

Background/Purpose: The purpose of this longitudinal study is to compare the effect of Adalimumab plus Methotrexate (MTX) versus MTX monotherapy on glycosaminoglycan content (GAG) in cartilage in patients with early rheumatoid arthritis (eRA) who have not received a disease-modifying antirheumatic drug (DMARD) or biological treatment using biochemical gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC).

Methods: Cartilage integrity of finger joints and the wrist of the clinically dominant hand of 14 patients with eRA who met the ACR/EULAR classification criteria were evaluated at baseline prior to any DMARD or biological therapy and 12 and 24 weeks after Adalimumab plus MTX therapy (10 patients, 6 females, mean age 44.9 years, range: 19-65 years) or placebo plus MTX therapy (4 patients, 2 female, mean age 46.7 years, range: 24-64 years). In this prospective double-blind study, patients were randomly assigned to both groups. dGEMRIC of MCP joints of the index and middle as well as OMERACT RAMRI scores, including synovitis, edema, and erosion subscores were registered at all timepoints.

Results: The Adalimumab + MTX therapy group showed a trend to higher dGEMRIC indices of the second and third MCP joints compared to the placebo + MTX therapy group between baseline and 24-week follow-up (ADA+MTX: dGEMRIC mean change 85.8, range -156.2 – 346.5; Placebo+MTX: dGEMRIC mean change -30.75, range -273.0 – 131.0; p = 0.37). Furthermore, there has been an improvement between baseline and 24-week follow-up in RAMRI score for the total RAMRI score (ADA+MTX: mean change -5.6, range -17 – 4; Placebo+MTX: mean change -1.25, range -6 – 6). RAMRI score for synovitis improved for most patients under therapy (ADA+MTX: 70%; Placebo+MTX: 75%). RAMRI score for edema improved for some patients (ADA+MTX: 50%; Placebo+MTX: 25%). RAMRI score for erosion has remained almost unchanged (improvement ADA+MTX: 0%; Placebo+MTX: 25%).

Conclusion: In patients with eRA, Adalimumab therapy showed a trend towards biochemical cartilage improvement after 24 weeks therapy. One possible explanation is a reduction of inflammation at the level of the MCP joint by Adalimumab. These results support the concept of early treatment for RA to stop and even reverse cartilage damage in inflamed joints. Furthermore, dGEMRIC appears to be an important tool for the early detection of molecular cartilage damage in RA.

Disclosure: P. Sewerin, AbbVie, 2, 5, 8, Biogen, 5, 8, BMS, 5, 8, Celgene, 2, 5, 8, Chugai, 2, 5, 8, Hexal, 5, 8, Janssen-Cilag, 2, 5, 8, Lilly, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Roche, 5, 8, Sanofi-Genzyme, 5, 8, Swedish Orphan Biovitrum, 5, 8, UCB, 2, 5, 8; M. Frenken, None; R. Brinks, None; C. Schleich, None; D. Abrar, None; S. Vordenbaeumen, None; R. Sengewein, None; J. Richter, None; M. Schneider, None; B. Ostendorf, None.

To cite this abstract in AMA style:

Sewerin P, Frenken M, Brinks R, Schleich C, Abrar D, Vordenbaeumen S, Sengewein R, Richter J, Schneider M, Ostendorf B. Delayed Gadolinium-enhanced MR Imaging of Cartilage – A Pilot Study to Measure the Effect of Adalimumab Plus MTX versus Placebo Plus MTX on Cartilage in Early RA Patients (CAR-ERA-Study) [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/delayed-gadolinium-enhanced-mr-imaging-of-cartilage-a-pilot-study-to-measure-the-effect-of-adalimumab-plus-mtx-versus-placebo-plus-mtx-on-cartilage-in-early-ra-patients-car-era-study/. Accessed .

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