Cobra Therapy for Rheumatoid Arthritis

We would like to receive your comments and experiences with COBRA therapy in your practice. Furthermore, if you are interested in using material to facilitate prescription of the therapy, we would be happy to help. This is an exciting time in rheumatology because of treatment advances. Choice is never easy, however, especially for a chronic disease like RA where treatment can be prolonged, expensive, and associated with unknown risks. We believe that our experience in implementing the use of COBRA is valuable and should be considered as the treatment options in the future increase.

Drs. van Tuyl and Boers work in the departments of rheumatology and epidemiology and biostatistics at VU University Medical Center in Amsterdam, the Netherlands.

References

1. Boers M, Verhoeven AC, Markusse HM, et al. Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet. 1997;350:309-318.
2. Landewé RB, Boers M, Verhoeven AC, et al. COBRA combination therapy in patients with early rheumatoid arthritis: Long-term structural benefits of a brief intervention. Arthritis Rheum. 2002;46:347-356.
3. Goekoop-Ruiterman YP, De Vries-Bouwstra JK, Allaart CF, et al. Comparison of treatment strategies in early rheumatoid arthritis: A randomized trial. Ann Intern Med. 2007;146:406-415.
4. Korthals-de Bos I, Van Tulder M, Boers M, et al. Indirect and total costs of early rheumatoid arthritis: A randomized comparison of combined step-down prednisolone, methotrexate, and sulfasalazine with sulfasalazine alone. J Rheumatol. 2004:31:1709-1716.
5. Verhoeven AC, Bibo JC, Boers M, Engel GL, van der LS. Cost-effectiveness and cost-utility of combination therapy in early rheumatoid arthritis: Randomized comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone. COBRA Trial Group. Combinatietherapie Bij Reumatoide Artritis. Br J Rheumatol. 1998:37:1102-1109.
6. van Tuyl LH, Plass AM, Lems WF, Voskuyl AE, Dijkmans BA, Boers M. Why are Dutch rheumatologists reluctant to use the COBRA treatment strategy in early rheumatoid arthritis? Ann Rheum Dis. 2007;66:974-976.
7. van Tuyl LH, Plass AM, Lems WF, et al. Discordant perspectives of rheumatologists and patients on COBRA combination therapy in rheumatoid arthritis. Rheumatology. 2009;36:1380-1386.
8. van Tuyl LH, Boers M, Lems WF, et al. Survival, comorbidities and joint damage 11 years after the COBRA combination therapy trial in early rheumatoid arthritis. Ann Rheum Dis. 2010;69:807-812.
9. van Tuyl LH, Plass AM, Lems WF, et al. Facilitating the use of COBRA combination therapy in early rheumatoid arthritis: A pilot implementation study. J Rheumatol. 2009;36:1380-1386.