NEW YORK (Reuters Health)—Methotrexate with step-down glucocorticoid remission induction (COBRA Slim) is an effective, safe and feasible initial treatment strategy for patients with early rheumatoid arthritis (RA), researchers from Belgium report.
Patients with early RA should be treated rapidly, intensively and to target, according to current guidelines, they note in a paper online July 18 in Annals of the Rheumatic Diseases. But questions regarding the optimal dosage and combination of drugs remain.
Dr. Diederik De Cock from KU Leuven and colleagues in the CareRA trial compared the effectiveness of different initial conventional synthetic disease-modifying antirheumatic drug (csDMARD) combinations, with or without glucocorticoid remission induction, in 289 high-risk and 90 low-risk patients with early RA.
High-risk patients were randomized to COBRA Classic (weekly methotrexate, daily sulfasalazine and a weekly step-down scheme of oral prednisone); COBRA Slim (weekly methotrexate with a weekly step-down scheme of oral prednisone); or COBRA Avant Garde (weekly methotrexate, daily leflunomide and a weekly step-down scheme of oral prednisone). Low-risk patients were randomized to COBRA Slim or methotrexate tight step-up (with no oral steroids allowed).