RT Journal Article SR Electronic T1 MRI Results Following Discontinuation of Methotrexate in Patients With Rheumatoid Arthritis Treated With Subcutaneous Tocilizumab: The COMP-ACT MRI Substudy JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP jrheum.180953 DO 10.3899/jrheum.180953 A1 Charles Peterfy A1 Joel Kremer A1 William Rigby A1 Nora Singer A1 Christine Birchwood A1 Darcy Gill A1 William Reiss A1 Jinglan Pei A1 Margaret Michalska YR 2019 UL http://www.jrheum.org/content/early/2019/06/07/jrheum.180953.abstract AB Objective To assess differences in joint damage and inflammation using magnetic resonance imaging (MRI) between patients with rheumatoid arthritis (RA) who achieved low disease activity with tocilizumab (TCZ) + methotrexate (MTX) and subsequently continued or discontinued MTX. Methods In the COMP-ACT trial, US patients with RA received subcutaneous TCZ 162 mg + MTX. Those who achieved Disease Activity Score 28 calculated with erythrocyte sedimentation rate (DAS28-ESR) ≤ 3.2 at week 24 were randomized 1:1 (double-blind) to discontinue MTX (TCZ mono) or continue TCZ + MTX until week 52. In a subset of patients, 1.5 Tesla MRI was used to obtain images of bilateral hands and wrists at weeks 24 and 40. Outcomes included changes in MRI-assessed synovitis, osteitis, erosion, and cartilage loss from week 24 to week 40 and the proportion of patients with progression of each score. Results Of 296 patients who achieved DAS28-ESR ≤ 3.2 at week 24, 79 were enrolled in the pilot MRI sub-study and randomized to TCZ mono (n = 38) or TCZ + MTX (n = 41). Treatment with either TCZ mono or TCZ + MTX suppressed erosion progression, synovitis, osteitis, and cartilage loss. The proportion of patients with no progression in each outcome measure was similar between groups (range, TCZ mono: 87.9%-100.0%; TCZ + MTX: 89.7%-97.4%). Conclusion In a subset of patients who achieved low disease activity with TCZ + MTX, MRI changes were minimal in intra-articular inflammation and damage measures in patients who discontinued MTX vs those who continued TCZ + MTX.