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Extended report
Sustained inhibition of progressive joint damage with rituximab plus methotrexate in early active rheumatoid arthritis: 2-year results from the randomised controlled trial IMAGE
  1. Paul P Tak1,
  2. William Rigby2,
  3. Andrea Rubbert-Roth3,
  4. Charles Peterfy4,
  5. Ronald F van Vollenhoven5,
  6. William Stohl6,
  7. Emma Healy7,
  8. Eva Hessey7,
  9. Mark Reynard7,
  10. Tim Shaw7
  1. 1Division of Clinical Immunology and Rheumatology, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Medicine, Dartmouth Medical School/Dartmouth-Hitchcock Medical Centre, Lebanon, New Hampshire, USA
  3. 3Department of Internal Medicine, University of Cologne, Cologne, Germany
  4. 4Spire Sciences LLC, San Francisco, California, USA
  5. 5Department of Medicine, The Karolinska Institute, Stockholm, Sweden
  6. 6Department of Medicine, Division of Rheumatology, Los Angeles County/University of Southern California Medical Centre and University of Southern California Keck School of Medicine, Los Angeles, California, USA
  7. 7Roche Products, Welwyn Garden City, UK
  1. Correspondence to Professor Paul P Tak, Division of Clinical Immunology and Rheumatology, Academic Medical Centre/University of Amsterdam, F4-105, P O Box 22700, 1100 DE Amsterdam, The Netherlands; p.p.tak{at}


Background In the IMAGEstudy, rituximab plus methotrexate (MTX) inhibited joint damage and improved clinical outcomes at 1 year in MTX-naïve patients with early active rheumatoid arthritis.

Objective The aim of this study was to assess joint damage progression and clinical outcomes over 2 years.

Methods Patients (n=755) were randomised to receive rituximab 2×500 mg+MTX, 2×1000 mg+MTX or placebo+MTX. The placebo-controlled period continued to week 104. Two-year end points were defined as secondary or exploratory and included change in total Genant-modified Sharp score (mTSS), total erosion score and joint space narrowing score from baseline to week 104. Clinical efficacy and physical function end points were also assessed.

Results At 2 years, rituximab 2×1000 mg+MTX maintained inhibition of progressive joint damage versus MTX alone (mTSS change 0.41 vs 1.95; p<0.0001 (79% inhibition)), and a higher proportion of patients receiving rituximab 2×1000 mg+MTX had no radiographic progression over 2 years compared with those receiving MTX alone (57% vs 37%; p<0.0001). Contrary to 1-year results, exploratory analysis of rituximab 2×500 mg+MTX at 2 years showed that progressive joint damage was slowed by ∼61% versus placebo+MTX (mTSS, exploratory p=0.0041). Improvements in clinical signs and symptoms and physical function seen after 1 year in rituximab-treated patients versus those receiving placebo were maintained at year 2. Safety profiles were similar between groups.

Conclusions Treatment with rituximab 2×1000 mg+MTX was associated with sustained improvements in radiographic, clinical and functional outcomes over 2 years.

Clinical identifier NCT00299104.

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  • Funding Financial support for this study was obtained from F Hoffmann-La Roche, Genentech Inc and Biogen Idec.

  • Competing Interests PPT has served as a consultant to Roche and Genentech. WR has served as a paid consultant for Roche, Genentech and Biogen Idec; has been paid lecture fees by Genentech and Biogen Idec; and has received grant support from Roche. ARR has received honoraria for talks and consulting from Roche. CP is an employee and shareholder of Spire Sciences LLC and a shareholder of Synarc Inc, which provide clinical trials services for multiple pharmaceutical, biotechnology and medical device companies. RFvV has received research support and honoraria/consultancy from Abbott, Merck, Pfizer, Roche and UCB Pharma, as well as honoraria/consultancy from Bristol Myers Squibb. WS has received a research grant from Xencor. E Healy is an employee of and owns shares in Roche. E Hessey is an employee of Roche. MR was an employee of Roche at the time of trial conduct and manuscript preparation, owns shares in Roche and is now an employee of and owns shares in GlaxoSmithKline. TS was an employee of Roche at the time of trial conduct and manuscript preparation, owns shares in Roche and is now an employee of Celgene Corporation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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