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

[Guest guest]

Ann Rheum Dis. 2008 Aug 12.

Tight control and intensified COBRA combination therapy in early

rheumatoid arthritis: 90% remission in a pilot trial.

van Tuyl LH, Lems WF, Voskuyl AE, Kerstens PJ, Garnero P, Dijkmans BA, Boers M.

VU University Medical Center, Netherlands.

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://www.ncbi.nlm.nih.gov/pubmed/18625629

--

Not an MD