title: Sustained improvements in MRI outcomes with abatacept following the withdrawal of all treatments in patients with early, progressive rheumatoid arthritis.
abstract: OBJECTIVE
  To assess structural damage progression with subcutaneous abatacept (ABA) in the Assessing Very Early Rheumatoid arthritis Treatment (AVERT) trial following abrupt withdrawal of all rheumatoid arthritis (RA) medication in patients achieving Disease Activity Score (DAS)-defined remission or low disease activity.
  
  
  METHODS
  Patients with early, active RA were randomised to ABA plus methotrexate (ABA/MTX) 125 mg/week, ABA 125 mg/week or MTX for 12 months. All RA treatments were withdrawn after 12 months in patients with DAS28 (C reactive protein (CRP)) <3.2. Adjusted mean changes from baseline in MRI-based synovitis, osteitis and erosion were calculated for the intention-to-treat population.
  
  
  RESULTS
  351 patients were randomised and treated: ABA/MTX (n=119), ABA (n=116) or MTX (n=116). Synovitis and osteitis improved, and progression of erosion was statistically less with ABA/MTX versus MTX at month 12 (-2.35 vs -0.68, -2.58 vs -0.68, 0.19 vs 1.53, respectively; p<0.01 for each) and month 18 (-1.34 vs -0.49 -2.03 vs 0.34, 0.13 vs 2.0, respectively; p<0.01 for erosion); ABA benefits were numerically intermediate to those for ABA/MTX and MTX.
  
  
  CONCLUSIONS
  Structural benefits with ABA/MTX or ABA may be maintained 6 months after withdrawal of all treatments in patients who have achieved remission or low disease activity.
  
  
  BACKGROUND
  NCT01142726; Results.
authors: Spire Sciences, Inc., Boca Raton, Florida, USA.
authors: Charles
authors: C
authors: Peterfy
authors: Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany.
authors: Gerd R
authors: GR
authors: Burmester
authors: Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA.
authors: Vivian P
authors: VP
authors: Bykerk
authors: Department of Rheumatology, Service d'Immuno-Rheumatologie, Montpellier, France.
authors: Bernard G
authors: BG
authors: Combe
authors: Spire Sciences, Inc., Boca Raton, Florida, USA.
authors: Julie C
authors: JC
authors: DiCarlo
authors: Department of Medicine, University of California Los Angeles, Los Angeles, California, USA.
authors: Daniel E
authors: DE
authors: Furst
authors: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Tom W J
authors: TW
authors: Huizinga
authors: Bristol-Myers Squibb, Princeton, New Jersey, USA.
authors: Dennis A
authors: DA
authors: Wong
authors: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors: Philip G
authors: PG
authors: Conaghan
authors: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors: Paul
authors: P
authors: Emery
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006801:Humans; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000627:therapeutic use; D010000:Osteitis / Q000000981:diagnostic imaging / Q000188:drug therapy; D012074:Remission Induction; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D000069594:Abatacept; D008727:Methotrexate
keywords: Inflammation; Magnetic ResonaNce Imaging; Reactive arthritis