Objective: To investigate the efficacy and feasibility of an intensive combination therapy in early rheumatoid arthritis (RA) combined with monitoring of 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 therapy 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%). 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.
Conclusion: This small pilot study suggests that intensified and tightly controlled COBRA therapy is uniquely effective in early RA.
Statistics from Altmetric.com
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.