Is MRI a predictive biomarker for clinical response to biologics in rheumatoid arthritis?
Is MRI a predictive biomarker for clinical response to biologics in rheumatoid arthritis?
复制标题
MRI 是类风湿关节炎生物制剂临床反应的预测生物标志物吗？
DOI：
10.1136/annrheumdis-2017-211265
复制
发表时间：
2017
影响因子：
27.4
通讯作者：
Conaghan,PhilipG
中科院分区：
文献类型：
--
作者：
Baker,JoshuaF;Østergaard,Mikkel;Conaghan,PhilipG
我们感谢Sewerin等人提供的关于MRI对类风湿性关节炎(RA)临床反应的预测作用的数据。这项研究是在我们先前研究的基础上进行的，证明了MRI对放射学损伤进展的预测价值。2 Sewerin的这项研究建立在MRI作为成像生物标记物的证据基础上，证明了对临床反应的预测。研究人员使用了德国缓解+3队列，并研究了29名因疾病控制不充分而升级为生物治疗的患者。在治疗升级前RA MRI评分较高的患者中，临床欧洲风湿病联盟对生物反应的可能性更大。虽然这些研究结果需要在更大的队列中重复，但这项研究提供了初步证据，表明MRI措施可以帮助预测谁最有可能从更积极的干预中受益。MRI比临床评估更准确地识别临床相关滑膜炎的概念已经确立。4为什么MRI可能是一个有用的预测治疗反应的生物标志物的一个假设是，一些明显活动的类风湿关节炎患者由于合并疾病而不是活动的关节炎症而有更高的疾病活动指标。例如，最近的一项研究表明，肥胖患者达到临床缓解的可能性较小。5那些没有炎症性疾病客观证据的疾病活动性指标升高的患者，如果对RA进行更积极的治疗，情况不太可能得到改善。相比之下，那些MRI检测到的活动度更高的人可能会有更大比例的临床疾病活动被活动期RA解释。这项研究的局限性是样本量小，缺乏对研究人群的更详细的描述。然而，这项研究开始回答RA的一个重要问题，即MRI能否帮助风湿科医生对治疗升级做出更准确的决定？考虑到升级到生物治疗会增加副作用和成本的风险，定义关节破坏风险最大和最有可能在临床上受益的生物标记物是主要感兴趣的。尽管核磁共振很昂贵，但在使用它可以防止不必要或不适当地使用更昂贵和更长期的疗法的情况下，核磁共振很可能是具有成本效益的。
We thank Sewerin et al 1 for the data they have provided on the predictive role of MRI for clinical response in rheumatoid arthritis (RA). This study follows on from our previous study demonstrating the predictive value of MRI for radiographic damage progression. 2 This study by Sewerin builds on the evidence for MRI as an imaging biomarker by demonstrating a prediction of clinical response. The investigators used the German REMISSION-PLUS 3 cohort and studied 29 patients who were being escalated to biologic therapy due to inadequate disease control. Clinical European League Against Rheumatism response to the biologic was more likely in those with higher RA MRI scores prior to the escalation of therapy. While these study results need to be replicated in a larger cohort, this study provides initial evidence that MRI measures can help predict who is most likely to benefit from more aggressive interventions.The concept that MRI more accurately identifies clinically relevant synovitis than clinical assessment is well established. 4 One hypothesis for why MRI might be a useful predictive biomarker for therapeutic response is that some patients with apparently active RA have elevated disease activity measures due to comorbid conditions, rather than active joint inflammation. For example, a recent study showed that obese patients are less likely to reach clinical remission. 5 Those with elevated disease activity measures without objective evidence of inflammatory disease would be very unlikely to improve with more aggressive treatment of the RA. In contrast, those with greater MRI-detected activity might be expected to have a greater proportion of their clinical disease activity explained by active RA. Limitations of this study are the small sample size and lack of a more detailed characterisation of the study population. However, this study begins to answer an important question in RA, namely—can MRI help rheumatologists make more accurate decisions about escalation of therapy? Given that escalation to biologic therapy involves increased risk of side effects and cost, biomarkers that define both cases at greatest risk of joint destruction and those most likely to benefit clinically are of major interest. MRI, despite being expensive, is likely to be costeffective in circumstances when its use prevents unnecessary or inappropriate use of much more expensive and long-term therapies.