Rasch Linda A, van Tuyl Lilian H D, Lems Willem F, Boers Maarten
Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
Neuroimmunomodulation. 2015;22(1-2):51-6. doi: 10.1159/000362728. Epub 2014 Sep 12.
Treatment with initial high-dose prednisolone and a combination of methotrexate (MTX) and sulfasalazine (SSZ) according to the COBRA regimen (Dutch acronym for combinatietherapie bij reumatoide artritis, 'combination therapy for rheumatoid arthritis'), has repeatedly been demonstrated to be very effective in early rheumatoid arthritis (RA). COBRA combination therapy is superior to initial monotherapy of SSZ and MTX, is also associated with a good long-term outcome, is as safe as other treatment regimes, and performs as well as the combination of high-dose MTX and the tumor necrosis factor antagonist infliximab. A pilot study with an intensified version of the COBRA combination therapy showed that strict monitoring and aggressive treatment intensification based on the Disease Activity Score can result in a remission rate of 90% in patients with active early RA. Also, the first results indicate that an attenuated variation on COBRA combination therapy, called 'COBRA-light', is effective in decreasing disease activity and is generally well tolerated. Based on these results, we conclude that initial high-dose prednisolone in combination with MTX and SSZ could or should be the first choice in early active RA since it is effective and safe, and the cost price of the drugs is low.
根据COBRA方案（荷兰语“类风湿性关节炎联合治疗”的首字母缩写），采用初始大剂量泼尼松龙以及甲氨蝶呤（MTX）和柳氮磺胺吡啶（SSZ）联合治疗，已反复证明对早期类风湿性关节炎（RA）非常有效。COBRA联合治疗优于SSZ和MTX的初始单一疗法，也具有良好的长期疗效，与其他治疗方案一样安全，且效果与大剂量MTX和肿瘤坏死因子拮抗剂英夫利昔单抗联合使用相当。一项关于强化版COBRA联合治疗的初步研究表明，基于疾病活动评分进行严格监测和积极强化治疗，可使活动性早期RA患者的缓解率达到90%。此外，初步结果表明，一种名为“COBRA-light”的COBRA联合治疗简化变体在降低疾病活动度方面有效，且总体耐受性良好。基于这些结果，我们得出结论，初始大剂量泼尼松龙联合MTX和SSZ可以或应该成为早期活动性RA的首选治疗方法，因为它有效、安全，且药物成本低廉。
