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Ultrasound may identify early joint changes from abatacept in patients with RA
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Power Doppler and grayscale ultrasound scores were responsive to changes in joints following administration of abatacept to patients with rheumatoid arthritis, according to published study data.
Researchers studied data from 89 patients with rheumatoid arthritis (RA) who completed a 24-week treatment period in an open-label, multicenter single arm study of abatacept (Orencia, Bristol-Myers Squibb). Individual joints were evaluated with a composite power Doppler ultrasound (PDUS) score, developed by the Outcome Measures in Rheumatology-European League Against Rheumatism (OMERACT-EULAR)-Ultrasound Task Force. Maximal scores for each joint were added to a Global OMERACT-EULAR Synovitis Score (GLOESS) for bilateral metacarpophalangeal joints 2-5 at baseline. Other joint sets were evaluated for comparison, and additional screening occurred at 1, 2, 4, 6, 8, 12, 16, 20 and 24 weeks.
“The composite OMERACT PDUS score is a combined score obtained from inflammatory (ie, hypoechoic) synovial hyperplasia (SH) and power Doppler signal (PD) in the scanned joints; joint effusion is not used. SH determines the score. Therefore, in the absence of PD the presence of grayscale SH gives the final composite PDUS score,” Maria-Antonietta D’Agostino, MD, PhD, professor of rheumatology at the University Paris Ouest-Versailles-Saint-Quentin-en-Yvelines, told Healio Rheumatology. “Since Doppler sensitivity can vary according to the quality of the machine used, the combined score permits to avoid underestimation of inflammation measured by Doppler alone.”
Signs of improvement were observed on PDUS as early as 1 week with a mean reduction from baseline GLOESS of 0.7. Similar trends in PDUS scores were observed in synovitis in individual joints, with statistically significant improvements at week 1. A significant reduction in SH was seen by week 2, while joint effusion showed statistically significant reductions at week 4.
“Based on the results of our study, we can suggest to perform an [ultrasound] evaluation as early as possible, for example, 1 month,” D’Agostino said. “However if patients can’t be seen within this short interval, 3 months is important as at that time we can catch both clinical and imaging response.”
D’Agostino told Healio Rheumatology she would expect to see similar PDUS activity with tumor necrosis factor (TNF) inhibitor treatments as well.
“PDUS is a very sensitive tool and early response has also been seen under anti-TNF blocker therapy. I would say that if the drug is efficacious on synovial activity, PDUS is able to capture the response,” she said. – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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D’Agostino MA, et al. Ann Rheum Dis. 2015;doi:10.1136/annrheumdis-2015-207709.
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