THU0141 Long-term effects on bone mineral density after four years of treatment with two intensive combination strategies, including initially high dose prednisolone, in early rheumatoid arthritispatients: the cobra-light trial

Background COmbinatie therapie Bij Reumatoide Artiritis (COBRA)-light therapy (methotrexate and initially 30 mg/day prednisolone) has proven to be non-inferior to COBRA therapy (methotrexate, sulfasalazine and initially 60 mg/day prednisolone) in the first year of treatment of early rheumatoid arthritis (RA) patients. Objectives This study assessed changes in bone mineral density (BMD) after four years in early RA patients initially randomised to one year of COBRA or COBRA-light therapy. Methods In the open-label, randomised, non-inferiority trial patients were assigned to COBRA or COBRA-light therapy. After one year, treatment was at the discretion of the treating rheumatologists. BMD in g/cm2 was measured at baseline, after one, two and four years at total hip, femoral neck, and lumbar spine with dual-energy X-ray absorptiometry (DXA). Results Of the 164 original patients, 154 could be assessed after a follow-up of four years (range 34 to 74 months); 68% were female; mean (SD) age at follow-up 5213 years. In the COBRA-light group, 11% of the patients used bisphosphonates after four years; the mean cumulative prednisolone dosage was 2.6 g (inner quartiles:1.9; 5.9) and 49% of the patients had minimal disease activity (DAS44 Outcomes are mean (SD) unless stated otherwise. BMD in g/cm2.+Significant difference between COBRA-light and COBRA on average over time. *Adjusted for bisphosphonate usage (yes vs no). **Adjusted for bisphosphonate usage (yes vs no), cumulative prednisolone usage, age, gender and disease activity based on DAS44 (DAS44 Conclusions In modern treat-to-target management of RA, including bone surveillance, a high starting dose of prednisolone, either 30 or 60 mg/day, was not associated with a dramatically increased bone loss at the lumbar spine, and minor losses at the hip over four years. Disclosure of Interest M. Lucassen: None declared, M. ter Wee: None declared, D. den Uyl: None declared, N. Konijn: None declared, M. Nurmohamed Speakers bureau: Janssen, Roche, MSD, Pfizer, Eli Lilly, BMS and Abbvie, D. van Schaardenburg: None declared, P. Kerstens: None declared, I. Bultink Speakers bureau: Lilly Netherlands, MSD, Amgen BV, UCB Pharma BV, Sanofi Genzyme BV, L. Van Tuyl: None declared, M. Boers Consultant for: Pfizer, Union Chimique Belge and Teva, W. Lems Grant/research support from: Pfizer, Speakers bureau: Pfizer, Abbvie and Roche