NEW YORK (Reuters Health) Mar 11 – Radiographic progression in rheumatoid arthritis remains suppressed for several years when brief but intensive combination therapy, which includes an oral pulse of prednisolone, is administered early in the course of the disease, researchers based in the Netherlands conclude following long-term follow-up of patients in the Combinatietherapie Bij Reumatoide Artritis (COBRA) trial.
Dr. Robert B. M. Landewe, of the University Hospital Maastricht, and colleagues report in the February issue of Arthritis and Rheumatism the results of the 5-year follow-up of 148 patients who participated in the COBRA trial.
The intensive treatment arm of the COBRA trial included prednisolone, 60 mg/day, tapered after 6 weeks and continued at 7.5 g/day for 28 weeks; methotrexate 7.5 mg/week, tapered and then stopped after 40 weeks; and sulfasalazine 2 grams/day. Results showed that, at 56 weeks, intensive therapy was more effective than sulfasalazine alone in suppressing disease activity and radiographic progression.
Even though joint damage scores increased over time, the mean change per year was 35% lower in those treated with multiple drugs compared with those given monotherapy (p = 0.03), both in terms of erosions and joint space narrowing. Furthermore, the rate of radiologic progression stabilized at a level lower than that reached in the monotherapy group. The authors estimate that the between-group difference would not resolve until after approximately 7 years.
The two groups did not differ significantly over time in terms of Health Assessment Questionnaire scores or disease activity, and the use of disease-modifying antirheumatic drugs (DMARDs) was similar between groups. Thus, the decreases in radiologic progression could not be explained by differences in disease activity or in therapy following the end of the trial.
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