RESEARCH - Tight control and intensified COBRA combination therapy in early RA: 90% remission in a pilot trial

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Ann Rheum Dis. Published Online First: 14 July 2008. doi:10.1136/ard.2008.090712

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Concise Report

Tight control and intensified COBRA combination therapy in early

rheumatoid arthritis: 90% remission in a pilot trial

Lilian HD van Tuyl 1*, Willem F Lems 1, andre E Voskuyl 1, Pit JSM

Kerstens 2, Garnero 3, Ben AC Dijkmans 1 and Maarten Boers 1

1 VU University Medical Center, Netherlands

2 Jan van Breemen Institute, Netherlands

3 Synarc SAS, France

Abstract

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.

http://ard.bmj.com/cgi/content/abstract/ard.2008.090712v1?papetoc

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