Dr. Østergaard has received consulting fees, speaking fees, and/or honoraria from Abbott, Bristol-Myers Squibb, Centocor, Roche, GlaxoSmithKline, Pfizer, MSD, UCB, and Wyeth (less than $10,000 each).
Significant improvement in synovitis, osteitis, and bone erosion following golimumab and methotrexate combination therapy as compared with methotrexate alone: A magnetic resonance imaging study of 318 methotrexate-naive rheumatoid arthritis patients†
Article first published online: 29 NOV 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 63, Issue 12, pages 3712–3722, December 2011
How to Cite
Østergaard, M., Emery, P., Conaghan, P. G., Fleischmann, R., Hsia, E. C., Xu, W. and Rahman, M. U. (2011), Significant improvement in synovitis, osteitis, and bone erosion following golimumab and methotrexate combination therapy as compared with methotrexate alone: A magnetic resonance imaging study of 318 methotrexate-naive rheumatoid arthritis patients. Arthritis & Rheumatism, 63: 3712–3722. doi: 10.1002/art.30592
ClinicalTrials.gov identifier: NCT00264537.
- Issue published online: 29 NOV 2011
- Article first published online: 29 NOV 2011
- Accepted manuscript online: 30 AUG 2011 10:09AM EST
- Manuscript Accepted: 3 AUG 2011
- Manuscript Received: 3 NOV 2010
- Centocor Research & Development, a division of Johnson & Johnson Pharmaceutical Research & Development, LLC
- Schering-Plough/Merck Research Institute, Inc.
To evaluate the effects of golimumab on inflammation/structural damage detected by magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA).
Methotrexate (MTX)–naive RA patients (n = 637) were randomized to placebo plus MTX, golimumab 100 mg plus placebo, golimumab 50 mg plus MTX, or golimumab 100 mg plus MTX (subcutaneous golimumab every 4 weeks). Of these, 318 patients participated in an MRI substudy. MRIs (contrast-enhanced; 1.5T) of the wrist and second through fifth metacarpophalangeal joints of the dominant hand were obtained at baseline and weeks 12 and 24. MRIs were scored by 2 independent readers (blinded to image sequence/chronology, patient identity, and treatment group) for synovitis, bone edema/osteitis, and bone erosions using the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) system. Radiographs (hands, wrists, forefeet at baseline and week 28) were scored by 2 other readers (blinded as above) using the modified Sharp/van der Heijde (SvdH) scoring system. Changes from baseline were compared between treatment groups (two-sided analysis of variance on van der Waerden normal scores).
At weeks 12 and 24, combined therapy with golimumab plus MTX versus placebo plus MTX significantly improved RAMRIS scores for synovitis (mean −1.92 versus 0.14 [P < 0.001] at week 12; −2.45 versus −1.04 [P < 0.001] at week 24), osteitis (mean −1.82 versus 0.56 [P < 0.001] at week 12; −2.27 versus −0.32 [P < 0.001] at week 24), and bone erosion (mean −0.40 versus 0.24 [P = 0.016] at week 12; −0.40 versus −0.24 [P = 0.010] at week 24). Results of sensitivity analyses (no missing doses/data and using linear extrapolation) were generally consistent with results of the primary analyses. Changes in SvdH scores among the MRI substudy patients at week 28 showed no significant difference between golimumab plus MTX therapy and placebo plus MTX (mean 0.49 versus 0.92; P = 0.19). Radiographic SvdH scores demonstrated inhibition of structural damage progression by treatment with golimumab plus MTX as compared with placebo plus MTX in the overall study population but required double the number of patients (637 versus 318) and double the length of followup (28 versus 12 weeks) as needed for MRI to demonstrate this.
Improvements in inflammation (synovitis and osteitis) and erosions with golimumab plus MTX therapy exceeded those with placebo plus MTX therapy from week 12 onward, confirming the overall clinical/radiologic findings. MRI was more sensitive than conventional radiography in detecting the progression of erosions.