Patients recently diagnosed with rheumatoid arthritis (RA) showed similar efficacy and safety outcomes during a 4-year follow-up period after receiving treatment with COBRA-light or COBRA therapy, according to results from a study published in Rheumatology.1
Researchers from VU University Medical Center, Reade and Westfriesgasthuis in The Netherlands, randomly assigned 162 patients (67% women; mean age, 56 years) recently diagnosed with RA (mean disease duration, 55 months) to receive COBRA-light (n=81; prednisolone plus methotrexate) or COBRA therapy (n=81; prednisolone, methotrexate, and sulfasalazine) for a period of 1 year. After the study period, treating physicians continued treatment without a protocol and adjusted it according to their clinical judgment, generally with a treat-to-target strategy.
Researchers then invited all patients to participate in a COBRA-light extension study 4 years after the trial began, in which they used patient interviews, physical examinations, self-reported outcomes, radiographs, clinical records (to determine comorbidities), and medication use. Ninety-two percent of the original trial participants took part in the extension study. Treatment with COBRA-light and COBRA therapy showed a similar effect on disease activity (as measured with the disease activity score in 44 joints), physical functioning (evaluated with the Health Assessment Questionnaire), radiological outcomes (as indicated by the radiological progression assessed with the Sharp-van der Heijde scoring), and Boolean remission during the 4-year follow-up period.
Both RA treatment groups showed similar comorbidity profiles and patterns of DMARD use over time, although power to detect differences was limited.
“Practical implications of our findings include a free choice for both physicians and patients to either start their treatment with COBRA-light or COBRA therapy; and assuming that barriers towards the use of COBRA therapy continue to [exist], COBRA-light is an equally effective and safe therapy to use in early active RA,” the researchers concluded. “As a whole, these results confirm the long-term efficacy of starting with induction therapy with combination therapy including glucocorticoids, followed by a maintenance therapy based on a treat-to-target strategy in early RA patients,” they added.
Konijn, N, Van Tuyl L, Boers M et al. Similar efficacy and safety of initial COBRA-Light and COBRA therapy in rheumatoid arthritis: 4-year results from the COBRA-light trial. Rheumatology 2017;56:1586-1596.