Methotrexate in combination with other DMARDs is not superior to methotrexate alone for remission induction with moderate-to-high-dose glucocorticoid bridging in early rheumatoid arthritis after 16 weeks of treatment: the CareRA trial

Diederik Decock; P Verschueren; D De Cock; L Corluy; R Joos; C Langenaken; V Taelman; F Raeman; I Ravelingien; K Vandevyvere; J Lenaerts; E Geens; P Geusens; J Vanhoof; A Durnez; J Remans; B Vander Cruyssen; E Van Essche; A Sileghem; G De Brabanter; J Joly; S Meyfroidt; K Van der Elst; R Westhovens

doi:10.1136/annrheumdis-2014-205489

Methotrexate in combination with other DMARDs is not superior to methotrexate alone for remission induction with moderate-to-high-dose glucocorticoid bridging in early rheumatoid arthritis after 16 weeks of treatment: the CareRA trial

Diederik Decock, P Verschueren, D De Cock, L Corluy, R Joos, C Langenaken, V Taelman, F Raeman, I Ravelingien, K Vandevyvere, J Lenaerts, E Geens, P Geusens, J Vanhoof, A Durnez, J Remans, B Vander Cruyssen, E Van Essche, A Sileghem, G De BrabanterJ Joly, S Meyfroidt, K Van der Elst, R Westhovens

The University of Manchester

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVES: To compare the efficacy and safety of intensive combination strategies with glucocorticoids (GCs) in the first 16 weeks (W) of early rheumatoid arthritis (eRA) treatment, focusing on high-risk patients, in the Care in early RA trial. METHODS: 400 disease-modifying antirheumatic drugs (DMARD)-naive patients with eRA were recruited and stratified into high risk or low risk according to classical prognostic markers. High-risk patients (n=290) were randomised to 1/3 treatment strategies: combination therapy for early rheumatoid arthritis (COBRA) Classic (methotrexate (MTX)+ sulfasalazine+60 mg prednisone tapered to 7.5 mg daily from W7), COBRA Slim (MTX+30 mg prednisone tapered to 5 mg from W6) and COBRA Avant-Garde (MTX+leflunomide+30 mg prednisone tapered to 5 mg from W6). Treatment modifications to target low-disease activity were mandatory from W8, if desirable and feasible according to the rheumatologist. The primary outcome was remission (28 joint disease activity score calculated with C-reactive protein

Original language	English
Pages (from-to)	27-34
Number of pages	8
Journal	Ann Rheum Dis
Volume	74
Issue number	1
DOIs	https://doi.org/10.1136/annrheumdis-2014-205489
Publication status	Published - 2015

Keywords

Adult
Aged
Antirheumatic Agents/*therapeutic use
Arthritis, Rheumatoid/diagnosis/*drug therapy
Drug Therapy, Combination/methods
Early Medical Intervention
Female
Glucocorticoids/*therapeutic use
Humans
Induction Chemotherapy/methods
Isoxazoles/*therapeutic use
Male
Methotrexate/*therapeutic use
Middle Aged
Prednisone/*therapeutic use
Risk Assessment
Severity of Illness Index
Sulfasalazine/*therapeutic use
Treatment Outcome

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10.1136/annrheumdis-2014-205489

http://www.ncbi.nlm.nih.gov/pubmed/25359382

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Decock, D., Verschueren, P., De Cock, D., Corluy, L., Joos, R., Langenaken, C., Taelman, V., Raeman, F., Ravelingien, I., Vandevyvere, K., Lenaerts, J., Geens, E., Geusens, P., Vanhoof, J., Durnez, A., Remans, J., Vander Cruyssen, B., Van Essche, E., Sileghem, A., ... Westhovens, R. (2015). Methotrexate in combination with other DMARDs is not superior to methotrexate alone for remission induction with moderate-to-high-dose glucocorticoid bridging in early rheumatoid arthritis after 16 weeks of treatment: the CareRA trial. Ann Rheum Dis, 74(1), 27-34. https://doi.org/10.1136/annrheumdis-2014-205489

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title = "Methotrexate in combination with other DMARDs is not superior to methotrexate alone for remission induction with moderate-to-high-dose glucocorticoid bridging in early rheumatoid arthritis after 16 weeks of treatment: the CareRA trial",

abstract = "OBJECTIVES: To compare the efficacy and safety of intensive combination strategies with glucocorticoids (GCs) in the first 16 weeks (W) of early rheumatoid arthritis (eRA) treatment, focusing on high-risk patients, in the Care in early RA trial. METHODS: 400 disease-modifying antirheumatic drugs (DMARD)-naive patients with eRA were recruited and stratified into high risk or low risk according to classical prognostic markers. High-risk patients (n=290) were randomised to 1/3 treatment strategies: combination therapy for early rheumatoid arthritis (COBRA) Classic (methotrexate (MTX)+ sulfasalazine+60 mg prednisone tapered to 7.5 mg daily from W7), COBRA Slim (MTX+30 mg prednisone tapered to 5 mg from W6) and COBRA Avant-Garde (MTX+leflunomide+30 mg prednisone tapered to 5 mg from W6). Treatment modifications to target low-disease activity were mandatory from W8, if desirable and feasible according to the rheumatologist. The primary outcome was remission (28 joint disease activity score calculated with C-reactive protein",

keywords = "Adult, Aged, Antirheumatic Agents/*therapeutic use, Arthritis, Rheumatoid/diagnosis/*drug therapy, Drug Therapy, Combination/methods, Early Medical Intervention, Female, Glucocorticoids/*therapeutic use, Humans, Induction Chemotherapy/methods, Isoxazoles/*therapeutic use, Male, Methotrexate/*therapeutic use, Middle Aged, Prednisone/*therapeutic use, Risk Assessment, Severity of Illness Index, Sulfasalazine/*therapeutic use, Treatment Outcome",

author = "Diederik Decock and P Verschueren and {De Cock}, D and L Corluy and R Joos and C Langenaken and V Taelman and F Raeman and I Ravelingien and K Vandevyvere and J Lenaerts and E Geens and P Geusens and J Vanhoof and A Durnez and J Remans and {Vander Cruyssen}, B and {Van Essche}, E and A Sileghem and {De Brabanter}, G and J Joly and S Meyfroidt and {Van der Elst}, K and R Westhovens",

note = "Verschueren, P De Cock, D Corluy, L Joos, R Langenaken, C Taelman, V Raeman, F Ravelingien, I Vandevyvere, K Lenaerts, J Geens, E Geusens, P Vanhoof, J Durnez, A Remans, J Vander Cruyssen, B Van Essche, E Sileghem, A De Brabanter, G Joly, J Meyfroidt, S Van der Elst, K Westhovens, R England Ann Rheum Dis. 2015 Jan;74(1):27-34. doi: 10.1136/annrheumdis-2014-205489. Epub 2014 Oct 30.",

year = "2015",

doi = "10.1136/annrheumdis-2014-205489",

language = "English",

volume = "74",

pages = "27--34",

journal = "Ann Rheum Dis",

issn = "0003-4967",

publisher = "Elsevier BV",

number = "1",

}

Decock, D, Verschueren, P, De Cock, D, Corluy, L, Joos, R, Langenaken, C, Taelman, V, Raeman, F, Ravelingien, I, Vandevyvere, K, Lenaerts, J, Geens, E, Geusens, P, Vanhoof, J, Durnez, A, Remans, J, Vander Cruyssen, B, Van Essche, E, Sileghem, A, De Brabanter, G, Joly, J, Meyfroidt, S, Van der Elst, K & Westhovens, R 2015, 'Methotrexate in combination with other DMARDs is not superior to methotrexate alone for remission induction with moderate-to-high-dose glucocorticoid bridging in early rheumatoid arthritis after 16 weeks of treatment: the CareRA trial', Ann Rheum Dis, vol. 74, no. 1, pp. 27-34. https://doi.org/10.1136/annrheumdis-2014-205489

Methotrexate in combination with other DMARDs is not superior to methotrexate alone for remission induction with moderate-to-high-dose glucocorticoid bridging in early rheumatoid arthritis after 16 weeks of treatment: the CareRA trial. / Decock, Diederik; Verschueren, P; De Cock, D et al.
In: Ann Rheum Dis, Vol. 74, No. 1, 2015, p. 27-34.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Methotrexate in combination with other DMARDs is not superior to methotrexate alone for remission induction with moderate-to-high-dose glucocorticoid bridging in early rheumatoid arthritis after 16 weeks of treatment: the CareRA trial

AU - Decock, Diederik

AU - Verschueren, P

AU - De Cock, D

AU - Corluy, L

AU - Joos, R

AU - Langenaken, C

AU - Taelman, V

AU - Raeman, F

AU - Ravelingien, I

AU - Vandevyvere, K

AU - Lenaerts, J

AU - Geens, E

AU - Geusens, P

AU - Vanhoof, J

AU - Durnez, A

AU - Remans, J

AU - Vander Cruyssen, B

AU - Van Essche, E

AU - Sileghem, A

AU - De Brabanter, G

AU - Joly, J

AU - Meyfroidt, S

AU - Van der Elst, K

AU - Westhovens, R

N1 - Verschueren, P De Cock, D Corluy, L Joos, R Langenaken, C Taelman, V Raeman, F Ravelingien, I Vandevyvere, K Lenaerts, J Geens, E Geusens, P Vanhoof, J Durnez, A Remans, J Vander Cruyssen, B Van Essche, E Sileghem, A De Brabanter, G Joly, J Meyfroidt, S Van der Elst, K Westhovens, R England Ann Rheum Dis. 2015 Jan;74(1):27-34. doi: 10.1136/annrheumdis-2014-205489. Epub 2014 Oct 30.

PY - 2015

Y1 - 2015

N2 - OBJECTIVES: To compare the efficacy and safety of intensive combination strategies with glucocorticoids (GCs) in the first 16 weeks (W) of early rheumatoid arthritis (eRA) treatment, focusing on high-risk patients, in the Care in early RA trial. METHODS: 400 disease-modifying antirheumatic drugs (DMARD)-naive patients with eRA were recruited and stratified into high risk or low risk according to classical prognostic markers. High-risk patients (n=290) were randomised to 1/3 treatment strategies: combination therapy for early rheumatoid arthritis (COBRA) Classic (methotrexate (MTX)+ sulfasalazine+60 mg prednisone tapered to 7.5 mg daily from W7), COBRA Slim (MTX+30 mg prednisone tapered to 5 mg from W6) and COBRA Avant-Garde (MTX+leflunomide+30 mg prednisone tapered to 5 mg from W6). Treatment modifications to target low-disease activity were mandatory from W8, if desirable and feasible according to the rheumatologist. The primary outcome was remission (28 joint disease activity score calculated with C-reactive protein

AB - OBJECTIVES: To compare the efficacy and safety of intensive combination strategies with glucocorticoids (GCs) in the first 16 weeks (W) of early rheumatoid arthritis (eRA) treatment, focusing on high-risk patients, in the Care in early RA trial. METHODS: 400 disease-modifying antirheumatic drugs (DMARD)-naive patients with eRA were recruited and stratified into high risk or low risk according to classical prognostic markers. High-risk patients (n=290) were randomised to 1/3 treatment strategies: combination therapy for early rheumatoid arthritis (COBRA) Classic (methotrexate (MTX)+ sulfasalazine+60 mg prednisone tapered to 7.5 mg daily from W7), COBRA Slim (MTX+30 mg prednisone tapered to 5 mg from W6) and COBRA Avant-Garde (MTX+leflunomide+30 mg prednisone tapered to 5 mg from W6). Treatment modifications to target low-disease activity were mandatory from W8, if desirable and feasible according to the rheumatologist. The primary outcome was remission (28 joint disease activity score calculated with C-reactive protein

KW - Adult

KW - Aged

KW - Antirheumatic Agents/therapeutic use

KW - Arthritis, Rheumatoid/diagnosis/drug therapy

KW - Drug Therapy, Combination/methods

KW - Early Medical Intervention

KW - Female

KW - Glucocorticoids/therapeutic use

KW - Humans

KW - Induction Chemotherapy/methods

KW - Isoxazoles/therapeutic use

KW - Male

KW - Methotrexate/therapeutic use

KW - Middle Aged

KW - Prednisone/therapeutic use

KW - Risk Assessment

KW - Severity of Illness Index

KW - Sulfasalazine/therapeutic use

KW - Treatment Outcome

U2 - 10.1136/annrheumdis-2014-205489

DO - 10.1136/annrheumdis-2014-205489

M3 - Article

SN - 0003-4967

VL - 74

SP - 27

EP - 34

JO - Ann Rheum Dis

JF - Ann Rheum Dis

IS - 1

ER -

Decock D, Verschueren P, De Cock D, Corluy L, Joos R, Langenaken C et al. Methotrexate in combination with other DMARDs is not superior to methotrexate alone for remission induction with moderate-to-high-dose glucocorticoid bridging in early rheumatoid arthritis after 16 weeks of treatment: the CareRA trial. Ann Rheum Dis. 2015;74(1):27-34. doi: 10.1136/annrheumdis-2014-205489