Relevance of the COBRA trial in current psoriasis practice.

The goal of psoriasis therapy is shifting from an emphasis on the short-term management of severe outbreaks to the maintenance of continuous long-term control. Topical corticosteroids play an important role in all of the therapeutic strategies used. The Clobex Spray Community-Based Research Assessment (COBRA) trial involved 455 community dermatologists throughout the United States who participated in a multicenter, 4-week, open-label, observational, community-based trial of twice-daily clobetasol propionate spray 0.05% as monotherapy or as an addition to a treatment regimen present at the time of study entry. Dermatologists were allowed to select study participants based on their own professional judgment, which resulted in the largest number of study participants ever enrolled in a psoriasis community-based trial, with 2488 subjects enrolled from 455 investigational sites. Of the total population, 1254 subjects with moderate to severe plaque psoriasis treated with clobetasol propionate spray 0.05% twice daily as monotherapy and 731 subjects treated with clobetasol propionate spray 0.05% twice daily in addition to an existing regimen were evaluated for efficacy with at least one follow-up visit. Data from this trial suggest that superpotent topical corticosteroids are appropriate for use as monotherapy and when added to existing therapeutic regimens. The effectiveness and tolerability results from this study suggest that clobetasol propionate spray 0.05% is a potent, well-tolerated, and versatile topical therapy for moderate to severe plaque psoriasis that may be used in a diverse range of settings to help dermatologists optimize response to therapy.