Magnetic resonance imaging characteristics in patients with spondyloarthritis and clinical diagnosis of heel enthesitis: post hoc analysis from the phase 3 ACHILLES trial
Abstract Objective To investigate the imaging characteristics and clinically assess heel enthesitis in spondyloarthritis (SpA) by applying in a post hoc analysis the Heel Enthesitis Magnetic Resonance Imaging Scoring system (HEMRIS) in blinded and centrally-read MRI data from the ACHILLES trial (NCT...
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| Language: | English |
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BMC
2022-05-01
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| Series: | Arthritis Research & Therapy |
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| Online Access: | https://doi.org/10.1186/s13075-022-02797-8 |
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| author | X. Baraliakos P. Sewerin E. de Miguel E. Pournara C. Kleinmond A. Shekhawat C. Jentzsch A. Wiedon F. Behrens on behalf of the ACHILLES study group |
| author_facet | X. Baraliakos P. Sewerin E. de Miguel E. Pournara C. Kleinmond A. Shekhawat C. Jentzsch A. Wiedon F. Behrens on behalf of the ACHILLES study group |
| author_sort | X. Baraliakos |
| collection | DOAJ |
| description | Abstract Objective To investigate the imaging characteristics and clinically assess heel enthesitis in spondyloarthritis (SpA) by applying in a post hoc analysis the Heel Enthesitis Magnetic Resonance Imaging Scoring system (HEMRIS) in blinded and centrally-read MRI data from the ACHILLES trial (NCT02771210). Methods ACHILLES included patients (≥18 years) with active psoriatic arthritis or axial SpA with clinical and MRI-positive heel enthesitis refractory to standard treatment. Patients were randomized to receive subcutaneous secukinumab 150/300 mg or placebo. At week 24, patients on placebo were switched to secukinumab treatment. MRI-positive heel enthesitis was confirmed in all patients by local investigators. MRIs were performed at 3 timepoints: screening and weeks 24 and 52. In the present analysis, all MRIs were re-evaluated by 2 blinded central readers in a consensus read fashion for a priori defined MRI parameters based on HEMRIS. Results At screening, 171/204 (83.8%) of patients presented with entheseal inflammation and/or structural damage, considering both the Achilles tendon and plantar fascia. Pathologies were more evident in the Achilles tendon area compared to the plantar aponeurosis. The most frequent pathologies were intra-tendon hypersignal and retrocalcaneal bursitis. The mean total entheseal inflammation score at screening in the Achilles tendon area was 2.99 (N=204) and the mean change (standard deviation [SD]) from screening to weeks 24 and 52 was − 0.91 (1.99) and − 0.83 (2.12) in the secukinumab group vs − 0.48 (1.86) and − 0.80 (1.98) in the placebo-secukinumab group, respectively. The mean total structural damage score at screening was 1.36 (N=204) and the mean change (SD) from screening to weeks 24 and 52 was 0.00 (0.65) and − 0.06 (0.56) in the secukinumab group vs 0.08 (0.48) and 0.04 (0.75) in the placebo-secukinumab group, respectively. Conclusions Based on the newly developed HEMRIS, entheseal inflammation and/or structural damage was confirmed in 83.3% of ACHILLES patients. Pathologies were more evident in the Achilles tendon area compared to plantar fascia, with the inflammatory parameters being more responsive with secukinumab treatment compared to placebo. The present analysis, with detailed information on individual MRI parameters, contributes to the scientific debate on heel enthesitis. Trial registration ClinicalTrials.gov NCT02771210 . |
| first_indexed | 2024-12-12T08:24:16Z |
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| id | doaj.art-b954111f6afa4037bbab864d3920dc13 |
| institution | Directory Open Access Journal |
| issn | 1478-6362 |
| language | English |
| last_indexed | 2024-12-12T08:24:16Z |
| publishDate | 2022-05-01 |
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| series | Arthritis Research & Therapy |
| spelling | doaj.art-b954111f6afa4037bbab864d3920dc132022-12-22T00:31:18ZengBMCArthritis Research & Therapy1478-63622022-05-0124111110.1186/s13075-022-02797-8Magnetic resonance imaging characteristics in patients with spondyloarthritis and clinical diagnosis of heel enthesitis: post hoc analysis from the phase 3 ACHILLES trialX. Baraliakos0P. Sewerin1E. de Miguel2E. Pournara3C. Kleinmond4A. Shekhawat5C. Jentzsch6A. Wiedon7F. Behrens8on behalf of the ACHILLES study groupRheumazentrum Ruhrgebiet-Ruhr-University BochumRheumazentrum Ruhrgebiet-Ruhr-University BochumRheumatology Department, Hospital Universitario La PazNovartis Pharma AGClinProject GmbHNovartis Healthcare Private LimitedNovartis Pharma GmbHNovartis Pharma GmbHCIRI/Rheumatology and Fraunhofer TMP, Goethe-UniversityAbstract Objective To investigate the imaging characteristics and clinically assess heel enthesitis in spondyloarthritis (SpA) by applying in a post hoc analysis the Heel Enthesitis Magnetic Resonance Imaging Scoring system (HEMRIS) in blinded and centrally-read MRI data from the ACHILLES trial (NCT02771210). Methods ACHILLES included patients (≥18 years) with active psoriatic arthritis or axial SpA with clinical and MRI-positive heel enthesitis refractory to standard treatment. Patients were randomized to receive subcutaneous secukinumab 150/300 mg or placebo. At week 24, patients on placebo were switched to secukinumab treatment. MRI-positive heel enthesitis was confirmed in all patients by local investigators. MRIs were performed at 3 timepoints: screening and weeks 24 and 52. In the present analysis, all MRIs were re-evaluated by 2 blinded central readers in a consensus read fashion for a priori defined MRI parameters based on HEMRIS. Results At screening, 171/204 (83.8%) of patients presented with entheseal inflammation and/or structural damage, considering both the Achilles tendon and plantar fascia. Pathologies were more evident in the Achilles tendon area compared to the plantar aponeurosis. The most frequent pathologies were intra-tendon hypersignal and retrocalcaneal bursitis. The mean total entheseal inflammation score at screening in the Achilles tendon area was 2.99 (N=204) and the mean change (standard deviation [SD]) from screening to weeks 24 and 52 was − 0.91 (1.99) and − 0.83 (2.12) in the secukinumab group vs − 0.48 (1.86) and − 0.80 (1.98) in the placebo-secukinumab group, respectively. The mean total structural damage score at screening was 1.36 (N=204) and the mean change (SD) from screening to weeks 24 and 52 was 0.00 (0.65) and − 0.06 (0.56) in the secukinumab group vs 0.08 (0.48) and 0.04 (0.75) in the placebo-secukinumab group, respectively. Conclusions Based on the newly developed HEMRIS, entheseal inflammation and/or structural damage was confirmed in 83.3% of ACHILLES patients. Pathologies were more evident in the Achilles tendon area compared to plantar fascia, with the inflammatory parameters being more responsive with secukinumab treatment compared to placebo. The present analysis, with detailed information on individual MRI parameters, contributes to the scientific debate on heel enthesitis. Trial registration ClinicalTrials.gov NCT02771210 .https://doi.org/10.1186/s13075-022-02797-8SpondyloarthritisInflammationStructural damageHeelEnthesitisHEMRIS |
| spellingShingle | X. Baraliakos P. Sewerin E. de Miguel E. Pournara C. Kleinmond A. Shekhawat C. Jentzsch A. Wiedon F. Behrens on behalf of the ACHILLES study group Magnetic resonance imaging characteristics in patients with spondyloarthritis and clinical diagnosis of heel enthesitis: post hoc analysis from the phase 3 ACHILLES trial Arthritis Research & Therapy Spondyloarthritis Inflammation Structural damage Heel Enthesitis HEMRIS |
| title | Magnetic resonance imaging characteristics in patients with spondyloarthritis and clinical diagnosis of heel enthesitis: post hoc analysis from the phase 3 ACHILLES trial |
| title_full | Magnetic resonance imaging characteristics in patients with spondyloarthritis and clinical diagnosis of heel enthesitis: post hoc analysis from the phase 3 ACHILLES trial |
| title_fullStr | Magnetic resonance imaging characteristics in patients with spondyloarthritis and clinical diagnosis of heel enthesitis: post hoc analysis from the phase 3 ACHILLES trial |
| title_full_unstemmed | Magnetic resonance imaging characteristics in patients with spondyloarthritis and clinical diagnosis of heel enthesitis: post hoc analysis from the phase 3 ACHILLES trial |
| title_short | Magnetic resonance imaging characteristics in patients with spondyloarthritis and clinical diagnosis of heel enthesitis: post hoc analysis from the phase 3 ACHILLES trial |
| title_sort | magnetic resonance imaging characteristics in patients with spondyloarthritis and clinical diagnosis of heel enthesitis post hoc analysis from the phase 3 achilles trial |
| topic | Spondyloarthritis Inflammation Structural damage Heel Enthesitis HEMRIS |
| url | https://doi.org/10.1186/s13075-022-02797-8 |
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