Doppler ultrasound predicts successful discontinuation of biological DMARDs in rheumatoid arthritis patients in clinical remission
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Doppler ultrasound predicts successful discontinuation of biological DMARDs in rheumatoid arthritis patients in clinical remission. / 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.
In: Rheumatology (United Kingdom), Vol. 60, No. 12, 01.12.2021, p. 5549-5559.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Doppler ultrasound predicts successful discontinuation of biological DMARDs in rheumatoid arthritis patients in clinical remission
AU - Terslev, Lene
AU - Brahe, Cecilie Heegaard
AU - Hetland, Merete Lund
AU - Georgiadis, Stylianos
AU - Ellegaard, Karen
AU - Juul, Lars
AU - Huynh, Tuan
AU - Døhn, Uffe Møller
AU - Fana, Viktoria
AU - Møller, Torsten
AU - Krabbe, Simon
AU - Ørnbjerg, Lykke Midtbøll
AU - Glinatsi, Daniel
AU - Røgind, Henrik
AU - Hansen, Anette
AU - Nørregaard, Jesper
AU - Jacobsen, Søren
AU - Jensen, Dorte Vendelbo
AU - Manilo, Natalia
AU - Asmussen, Karsten
AU - Boesen, Mikael
AU - Rastiemadabadi, Zoreh
AU - Morsel-Carlsen, Lone
AU - Møller, Jakob Møllenbach
AU - Krogh, Niels Steen
AU - Østergaard, Mikkel
N1 - Publisher Copyright: © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - 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.
AB - 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.
KW - bDMARD
KW - clinical remission
KW - discontinuation
KW - Doppler
KW - synovial hypertrophy
KW - T2T strategy
KW - tapering
KW - ultrasound
KW - ultrasound remission
U2 - 10.1093/rheumatology/keab276
DO - 10.1093/rheumatology/keab276
M3 - Journal article
C2 - 33748831
AN - SCOPUS:85122435453
VL - 60
SP - 5549
EP - 5559
JO - Rheumatology
JF - Rheumatology
SN - 1462-0324
IS - 12
ER -
ID: 290254249