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Abstract Number: 798

Targeting Ultrasound Remission In Early Rheumatoid Arthritis – Results Of The Taser Study

James Dale1, Anne Stirling2, Iain B. McInnes1 and Duncan Porter3, 1Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom, 2Gartnavel General Hospital, Glasgow, United Kingdom, 3Rheumatology, Gartnavel General Hospital, Glasgow, United Kingdom

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Disease Activity, DMARDs, rheumatoid arthritis, treatment and ultrasound

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Session Information

Session Title: Rheumatoid Arthritis - Clinical Aspects I: Treatment Strategies in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose:

The TaSER study (NCT00920478) is an open label randomized clinical trial with blinded assessments of outcome. It was designed to test whether the efficacy of DAS28 driven treat-to-target DMARD strategies could be improved by the addition of regular musculoskeletal ultrasound (MSUS) disease activity assessment.

Methods:

111 untreated early UA/RA patients (symptom duration <1 year) were randomized to step-up DMARD escalation strategies guided by either DAS28 alone (target = DAS28<3.2) or DAS28+MSUS assessment of a limited joint set (target = PD signal in ≤1 joint). In the MSUS group, ultrasound assessment was undertaken in patients in LDAS, or moderate DAS but with minimal synovitis (28SJC²1). The follow-up period was 18 months. In the first 3 months both groups received identical treatment. Thereafter, treatment was escalated whenever the appropriate target was not achieved; through the addition of new DMARDs, DMARD dose optimisation, and/or IA/IM steroid. The sequence of DMARD escalation was: MTX � MTX/SSZ/HCQ � scMTX/SSZ/HCQ � etanercept/scMTX/SSZ/HCQ.

Outcomes were assessed every 3 months by a metrologist who was blinded to randomization group. The primary clinical outcome was the mean improvement in DAS44. Secondary outcome measures included: mean improvement in ACR core set variables and DAS44 remission rate. Radiological outcomes included the MRI RAMRIS score and Total Sharp Score (results still to be analysed)

Results:

110 (99%) patients fulfilled 2010 ACR/EULAR RA classification criteria. Both groups were well matched for disease duration (median 4m), baseline DAS (4.4), ACPA+ve (60%) and HAQ (1.6 v 1.5). The DAS28 group contained a higher proportion of females (60% vs 78%, p 0.031). Both groups experienced significant improvements in DAS44 (mean change in DAS44 -2.51 [DAS28] vs -2.76 [MSUS]; 95%CI -0.84, 0.33; p 0.39) and HAQ (-0.79 v -1.06; 95%CI -0.57, 0.031: p0.08). The DAS28 group had a numerically higher rate of DAS44 remission after 3 months (43% v 33%; p=0.32). However, after 18 months, more patients in the MSUS groups had attained DAS44 remission (44% v 65%; p=0.046). There was no difference in DAS44, HAQ or ACR core set variables at any time point

Conclusion:

Both groups exhibited similar, very robust improvements in clinical outcomes. MSUS disease activity assessment was not associated with improved clinical outcomes except a higher rate of DAS44 remission after 18 months.

Graph 1 – Mean change in DAS44 from baseline

Graph 2 – Proportion of patients achieving DAS44 remission (* p<0.05)


Disclosure:

J. Dale,

Pfizer Inc,

2;

A. Stirling,
None;

I. B. McInnes,

Pfizer Inc,

2,

Astra Zeneca,

2,

UCB,

5,

BMS,

2,

Pfizer Inc,

5,

Astra Zeneca,

5;

D. Porter,

Pfizer Inc,

2,

Medimmune,

5.

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