Article Text

Download PDFPDF
Tight control and intensified COBRA combination treatment in early rheumatoid arthritis: 90% remission in a pilot trial
  1. L H D van Tuyl1,
  2. W F Lems2,
  3. A E Voskuyl2,
  4. P J S M Kerstens3,
  5. P Garnero4,
  6. B A C Dijkmans2,
  7. M Boers5
  1. 1
    Department of Clinical Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
  2. 2
    Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
  3. 3
    Jan van Breemen Institute, Amsterdam, The Netherlands
  4. 4
    INSERM Unit 664 and Synarc, Lyon, France
  5. 5
    VU University Medical Center, Clinical Epidemiology & Biostatistics, Amsterdam, The Netherlands
  1. Lilian H D van Tuyl, VU University Medical Center, Department of Clinical Epidemiology & Biostatistics, PK 6Z 159, PO Box 7057, 1007 MB Amsterdam, The Netherlands; L.vantuyl{at}vumc.nl

Abstract

Objective: To investigate the efficacy and feasibility of an intensive combination treatment in early rheumatoid arthritis (RA) combined with monitoring both disease activity and cartilage degradation.

Methods: In a pilot trial, 21 patients with active early RA (mean DAS28 5.3; mean disease duration 3 months) were treated with COBRA treatment comprising sulfasalazine, methotrexate and high-dose step-down prednisolone, intensified by adding hydroxychloroquine and continued low-dose prednisolone. In addition, based on measurements of disease activity or a marker of cartilage degradation (CTX-II), treatment adjustments were possible with methotrexate intensification after 8 or 21 weeks; and with infliximab after 21 weeks.

Results: Nineteen of 21 patients (90%) were in remission (DAS28 <2.6) after 40 weeks (8 weeks, 57%; 21 weeks, 76%). American College of Rheumatology (ACR) criteria, ACR20, 50, 70 and 90 improvements rates were 100%, 95%, 71% and 43% respectively. CTX-II excretion decreased by mean (SD) 347(292) ng/mmol creatinine, but only 50% of patients reduced their CTX-II excretion below the cut-off point. The two monitoring groups showed no significant difference in remission according to DAS score or CTX-II excretion, despite a trend towards more intensive treatment in the CTX-II group. Treatment intensification was feasible according to protocol.

Conclusions: This small pilot study suggests that intensified and tightly controlled COBRA treatment is uniquely effective in early RA.

Trial registration number: ISRCTN96372677.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Footnotes

  • Funding: This study was supported by an unrestricted research grant from Schering Plough BV.

  • Competing interests: None.