Why are Dutch rheumatologists reluctant to use the COBRA treatment strategy in early rheumatoid arthritis?

Background: The COBRA trial has proved that combination therapy with prednisolone, methotrexate and sulfasalazine is superior to sulfasalazine monotherapy in suppressing disease activity and radiological progression of early rheumatoid arthritis (RA). In addition, five years follow-up proved that COBRA therapy results in sustained reduction of the rate of radiologic progression. Despite this evidence Dutch rheumatologists appear reluctant to prescribe COBRA-therapy. Objective: To explore the reasons for the reluctance to prescribe COBRA-therapy. Methods: A short structured questionnaire based... Mehr ...