TY - JOUR 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 DO - 10.3899/jrheum.180953 SP - jrheum.180953 AU - Charles Peterfy AU - Joel Kremer AU - William Rigby AU - Nora Singer AU - Christine Birchwood AU - Darcy Gill AU - William Reiss AU - Jinglan Pei AU - Margaret Michalska Y1 - 2019/06/01 UR - http://www.jrheum.org/content/early/2019/06/07/jrheum.180953.abstract N2 - 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. ER -