RESEARCH - Discordant perspectives of rheumatologists and patients on COBRA combination therapy in RA

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Rheumatology Advance Access published online on August 18, 2008

Rheumatology, doi:10.1093/rheumatology/ken323

Discordant perspectives of rheumatologists and patients on COBRA

combination therapy in rheumatoid arthritis

L. H. D. van Tuyl1, A. M. C. Plass2, W. F. Lems3, A. E. Voskuyl3, P.

J. S. M. Kerstens4, B. A. C. Dijkmans3 and M. Boers1

1Department of Clinical Epidemiology and Biostatistics,

2EMGO-Institute, 3Department of Rheumatology, VU University Medical

Center and 4Jan van Breemen Institute, Amsterdam, The Netherlands.

Abstract

Objective. The COBRA therapy (combination therapy in early rheumatoid

arthritis) has proven to be an effective treatment for early RA, but

is rarely prescribed. A survey showed reluctance of Dutch

reumatologists to apply COBRA therapy in early RA. The present

qualitative study was carried out to further explore the reservation

of Dutch rheumatologists towards prescribing COBRA therapy and include

patients' view on (components of) COBRA therapy.

Methods. Two focus group discussions were undertaken for

rheumatologists (n1 = 8, n2 = 7) and two for patients (n1 = 4, n2 =

8). In addition, in-depth interviews were conducted with 11

rheumatologists and 1 patient. These were taped and transcribed. Two

independent researchers identified themes and these were discussed

with three other researchers.

Results. Rheumatologists were positive concerning effectiveness of

COBRA therapy, but highly concerned about their patients' possible

negative reaction to the large amount of pills to be prescribed. In

addition, rheumatologists perceived lack of time explaining and

prescribing COBRA therapy and felt uncomfortable prescribing high

doses of prednisolone. Patients were positive about an aggressive

combination therapy such as COBRA, and they had no qualms taking many

pills if this could improve their prognosis. Patients associated

prednisolone with negative side-effects, but were also aware of the

benefits and the need of prednisolone in rough times. A decrease in

the amount of pills after intensive treatment was highly appreciated.

Conclusion. Rheumatologists and patients differed in opinion about the

use of COBRA therapy. Rheumatologists were particularly concerned

about their patients' reaction towards them prescribing such an

aggressive and complex therapy, whereas patients, while aware of the

side-effects, were most interested in suppressing illness symptoms and

reducing future damage regardless of the amount of pills.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken323v1?papetoc

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