Doppler ultrasound predicts successful discontinuation of biological DMARDs in rheumatoid arthritis patients in clinical remission. (20th March 2021)

• Record Type: Journal Article
• Authors: Terslev, Lene; Brahe, Cecilie Heegaard; Hetland, Merete Lund; Georgiadis, Stylianos; Ellegaard, Karen; Juul, Lars; Huynh, Tuan; Døhn, Uffe Møller; Fana, Viktoria; Møller, Torsten ; Krabbe, Simon; Ørnbjerg, Lykke Midtbøll; Glinatsi, Daniel; Røgind, Henrik; Hansen, Anette; Nørregaard, Jesper; Jacobsen, Søren; Jensen, Dorte Vendelbo; Manilo, Natalia ; Asmussen, Karsten; Boesen, Mikael; Rastiemadabadi, Zoreh; Morsel-Carlsen, Lone ; Møller, Jakob Møllenbach; Krogh, Niels Steen; Østergaard, Mikkel
• Is Part Of: Rheumatology. Volume 60:Number 12(2021)
• Page Start: 5549
• Page End: 5559
• Publication Date: 2021-03-20
• Subjects: ultrasound -- Doppler -- clinical remission -- tapering -- discontinuation -- bDMARD -- discontinuation -- synovial hypertrophy -- T2T strategy -- ultrasound remission; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keab276
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objective: To assess the ability of ultrasound to predict successful tapering and successful discontinuation of biological DMARDs (bDMARDs) at the 2-year follow-up in RA patients in sustained remission. Methods: Patients in sustained remission (DAS28-CRP ≤ 2.6) and with no radiographic progression the previous year tapered bDMARDs according to a standardized regime. A total of 119 of these patients were included in this ultrasound substudy. At baseline, clinical assessment, MRI, X-ray and ultrasound of 24 joints were performed. Ultrasound-detected synovitis was defined and scored 0–3 using the OMERACT scoring system at the joint level for both grey-scale and Doppler activity. Sum scores for each ultrasound modality were calculated for 24 joints at the patient level. The final state of treatment was assessed after 2 years. The predictive value of ultrasound measures for successful tapering and discontinuation at the 2-year follow-up was assessed via logistic regression analyses. Results: Negative IgM-RF [odds ratio (OR) = 0.29, 95% CI: 0.10–0.85; P = 0.024] and lower Doppler sum score of 24 joints (OR = 0.44, 95% CI: 0.15, 0.87; P = 0.014) were independent predictors for successful discontinuation of bDMARDs at the 2-year follow-up. The predictive value of the Doppler sum score was independent of MRI findings. Previous numbers of bDMARDs were predictive of successful tapering (OR = 0.58, 95% CI: 0.35, 0.91; P = 0.018), whereas ultrasound was not. Clinical parameters were not predictive of successful tapering/discontinuation. Conclusion: Doppler sum score was an independent predictor for successful discontinuation of bDMARDs at the 2-year follow-up—the odds for achieving successful discontinuation decreased by 56% per one-unit increase in Doppler sum score. Ultrasound could not predict successful tapering.