Responsiveness of different dynamic contrast-enhanced magnetic resonance imaging approaches: a post-hoc analysis of a randomized controlled trial of certolizumab pegol in rheumatoid arthritis

Abstract

Objective: The aim was to explore dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as an early marker of therapeutic response in patients with rheumatoid arthritis (RA) starting treatment with certolizumab pegol (CZP).

Method: In 40 RA patients initiating CZP (27 patients) or 2 weeks of placebo (PCB) followed by CZP (13 patients), DCE-MRI of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints was performed at weeks 0, 1, 2, 4, 8, and 16. Using semi-automated software, three methods for drawing volume regions of interest (ROIs) in MCP2–5 and PIP2–5 were applied: ‘Standard’ (slices: all; joints: MCP2–5 together and PIP2–5 together), ‘Detailed’ (slices: slices with high-quality visualization; joints: as Standard), and ‘Single-joint’ (slices: as Detailed; joints: each joint separately). The number of enhancing voxels (Nvoxel), initial rate of enhancement (IRE), and maximum enhancement (ME) were extracted and analysed for each method.

Results: Nvoxel in MCP2–5, and IRE and ME in PIP2–5 decreased statistically significantly (Wilcoxon rank-sum test, p < 0.02–0.03) after 16 weeks of treatment for the Standard method. Nvoxel and ME decreased significantly more in the CZP group than in the PCB group after 1 week of treatment, but not at later time-points. There were no significant changes for DCE-MRI parameters for the Detailed and Single-joint methods.

Conclusions: Certain DCE-MRI parameters detected decreased inflammation during CZP treatment in RA patients. Using specific criteria for ROIs, as in the Detailed and Single-joint methods, decreased the statistical power and could not show any changes over time.

Acknowledgements

We acknowledge the investigators and UCB personnel who contributed to the original study. UCB Pharma funded the original study and provided financial support for the analyses in the present report.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supporting Information

Additional Supporting Information may be found in the online version of this article.

Supplementary table S1. The ‘Detailed’ method. Change from baseline in Nvoxel, IRE and ME

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