title: Assessment by MRI of inflammation and damage in rheumatoid arthritis patients with methotrexate inadequate response receiving golimumab: results of the GO-FORWARD trial.
abstract: OBJECTIVE
  To evaluate golimumab's effect on MRI-detected inflammation and structural damage in patients with active rheumatoid arthritis (RA) despite methotrexate (MTX).
  
  
  METHODS
  Patients (n=444) were randomly assigned to placebo plus MTX, golimumab 100 mg plus placebo, golimumab 50 mg plus MTX, or golimumab 100 mg plus MTX (subcutaneous injections every 4 weeks). A subset of 240 patients participated in an MRI substudy. MRIs (1.5T+contrast enhancement) of the dominant wrist and metacarpophalangeal (MCP) joints were obtained at baseline and weeks 12 and 24. Images were scored by two independent, blinded readers for synovitis (0-9 wrist only (n=240), 0-21 wrist+MCP (n=223)), bone oedema (osteitis) (0-69) and bone erosions (0-230) using the OMERACT Rheumatoid Arthritis MRI Scoring system.
  
  
  RESULTS
  Significant improvements in synovitis and bone oedema (osteitis) were observed in the combined golimumab plus MTX groups versus placebo plus MTX at week 12 (-1.77 vs -0.15, p<0.001 wrist+MCP and -2.00 vs 0.19, p=0.003, respectively) and week 24 (-1.91 vs -0.38, p<0.001 wrist+MCP and -1.74 vs 0.71, p=0.004, respectively). Fewer than 10% of patients had a substantial degree of erosive progression (most showed no progression) across all treatment groups (including the control group), precluding adequate evaluation of golimumab's effect on bone erosions.
  
  
  CONCLUSIONS
  Golimumab plus MTX significantly improved MRI-detected synovitis and osteitis (prognosticators of future structural damage) versus placebo plus MTX at weeks 12 and 24. The effect of golimumab on bone erosions could not be determined by semi-quantitative scoring in these RA patients with minimal progression of bone erosions.
authors.affiliation: Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK. p.conaghan@leeds.ac.uk
authors.forename: Philip G
authors.initials: PG
authors.lastname: Conaghan
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
authors.forename: Mikkel
authors.initials: M
authors.lastname: Østergaard
authors.forename: Edward C
authors.initials: EC
authors.lastname: Keystone
authors.forename: Mark C
authors.initials: MC
authors.lastname: Genovese
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Hsia
authors.forename: Weichun
authors.initials: W
authors.lastname: Xu
authors.forename: Mahboob U
authors.initials: MU
authors.lastname: Rahman
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008662:Metacarpophalangeal Joint / Q000473:pathology; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D010000:Osteitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D013585:Synovitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D014955:Wrist Joint / Q000473:pathology
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; C529000:golimumab; D008727:Methotrexate