Radiography of rheumatoid arthritis in the time of increasing drug effectiveness

Abstract

Recent clinical development programs for new therapeutic agents in rheumatoid arthritis have included assessment of radiographic progression comparing changes with treatment to placebo and active controls. Studies now use reliable methods of assessment and sufficient study length to detect radiographic changes. Although patient populations and characteristics differ, and radiographic scoring methods vary, the direction of a series of studies appears to indicate that leflunomide (LEF), methotrexate (MTX), sulfasalazine (SSZ), etanercept, infliximab, and IL-1ra are all effective in retarding radiographic progression, as measured by erosions and joint space narrowing. Interpretation of radiograph data in future trials will be aided by utilization of common reading methods and by continuing comparison across differing rheumatoid arthritis protocol populations.

Radiographic data from recent randomized controlled trials in rheumatoid arthritis: What have we learned?

“…Additional analyses recommended at the National Institutes of Health consensus conference included several definitions of "no radiographic progression": the number (%) of patients with Յ0 change in composite scores at followup compared with baseline; the number (%) of patients with no newly eroded joints, and the number (%) of patients with Յ0 and/or Յ3 changes in erosion scores (10)(11)(12)(13)(14)(15)20,45). In the year 2 cohort of the ERA trial, 65% and 79% of patients with 0 scores at baseline in the methotrexate and 25-mg etanercept treatment groups, respectively, had change scores of Ͻ0.5 (23).…”

“…However, it is possible to compare the data if one utilizes an estimated yearly progression of radiographic damage, based on previous progression and assuming that patients remained on their previous treatment regimen or remained untreated. This value is obtained by dividing individual patient population baseline mean composite scores by their reported mean disease duration and obtaining a mean value, or estimated yearly progression, for the treatment group (8,(11)(12)(13)15,20) ( Table 1). The estimated yearly progression can be used as a "benchmark," allowing rough numerical comparisons with observed change scores, but it should not be used for statistical comparisons.…”