When it comes to treating rheumatoid arthritis (RA), less may be more. While some rheumatologists pull out the expensive, sometimes-risky “big guns” like biologics, or a heavy-handed course of DMARDs and NSAIDs right from the get-go, researchers have found that a simplified, less-costly approach may be the best way to manage early RA with fewer side effects.
A recent two-year study called CareRA shows that a combination of fewer drugs can be just as effective as more intensive approaches. This is potentially good news for RA patients because fewer, and simpler, drugs means less cost and fewer (often miserable) side effects.
Which Meds Work with This Slimmed-Down Regimen?
In the CareRA study, researchers looked at three approaches to treatment. Each proved to be similarly effective, leading to remission in seven out of every 10 patients. The most notable difference between the approaches was in terms of side effects.
According to KU Leuven hospital in Belgium, where the study was conducted, the trial involved 290 early-stage RA patients who were divided into three treatment groups. Each group received a different anti-rheumatic drug combination. One treatment plan was called COBRA Classic, and it included methotrexate, sulfasalazine, and a high first dose of glucocorticoids. The second group was called COBRA Avant-Garde, and included methotrexate, leflunomide, and a medium dose of glucocorticoids. Lastly, there was the COBRA Slim group, who only received methotrexate plus a moderate dose of glucocorticoids.
The COBRA Slim therapy group showed a significant decrease in side effects, yet the regimen was just as effective — a win-win for RA patients. It is also a simpler drug course to follow, which may encourage better patient adherence.
Many Patients Already on the COBRA Slim Course
Dr. Douglas Lienesch of the University of Pittsburgh Medical Center said, “The main takeaway point for me is that high doses of corticosteroids are not required to achieve lower disease activity in the short-term, and reinforces how well methotrexate works in many patients. This is good because most practicing rheumatologists, at least in the U.S., are uncomfortable with the amount of steroids used in the ‘classic’ COBRA regimen … In fact, many will start patients on methotrexate without any other RA drug, with the possible exception of corticosteroids at even lower doses than were used in the COBRA Slim regimen.”
He added, however, “Whether there is benefit to the use of the high doses of corticosteroids in the long term will have to await follow-up of patients in this study.”
For some patients, a particular drug regimen will work well at first and then lose efficacy over time. Meg Stedman, a patient with juvenile RA (JRA) from Fort Worth, Texas, has tried a protocol similar to COBRA Slim.
“When I was first diagnosed with JRA, COBRA Slim is what my first treatment option consisted of. I was on 5 mg of prednisone, and took 12.5 mg (6 pills a week) of methotrexate. It worked very well for almost two years. I had no flares, none really. Then, all of the sudden, it stopped working. I keep hoping to find something that will bring relief,” Stedman said.
While some patients like Stedman are still waiting for a drug treatment that will improve their symptoms and quality of life, others are having great success with COBRA Slim. It may be worth asking your rheumatologist or primary care doctor about this protocol for managing your RA, particularly if you are in the early stages of the disease.