PT  - JOURNAL ARTICLE
AU  - L H D van Tuyl
AU  - W F Lems
AU  - A E Voskuyl
AU  - P J S M Kerstens
AU  - P Garnero
AU  - B A C Dijkmans
AU  - M Boers
TI  - Tight control and intensified COBRA combination treatment in early rheumatoid arthritis: 90% remission in a pilot trial
AID  - 10.1136/ard.2008.090712
DP  - 2008 Nov 01
TA  - Annals of the Rheumatic Diseases
PG  - 1574--1577
VI  - 67
IP  - 11
4099  - http://ard.bmj.com/content/67/11/1574.short
4100  - http://ard.bmj.com/content/67/11/1574.full
SO  - Ann Rheum Dis2008 Nov 01; 67
AB  - 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.