Long-term treatment of systemic lupus erythematosus with cyclosporin A.

OBJECTIVE To evaluate the efficacy of long-term treatment with cyclosporin A (CSA) in systemic lupus erythematosus (SLE). METHODS Thirty patients with SLE whose condition was either poorly responsive or unresponsive to treatment with steroids and/or cytotoxic drugs were enrolled in a prospective, nonrandomized study of CSA. Patients with hypertension or hypercreatinemia were excluded. Disease activity was evaluated according to the systemic lupus activity measure. Assessments were made prior to study entry and after 6, 12, 18, and 24 months. RESULTS Twenty-seven patients completed at least 24 months of treatment with CSA. The mean disease activity score significantly decreased after 6 months of therapy (P < 0.01); this result was maintained throughout the study. A conspicuous steroid-sparing effect was observed following administration of CSA (P < 0.01). Side effects included hypertrichosis (63% of patients), paresthesias (23%), gastrointestinal symptoms (20%), gingival hyperplasia (17%), hypertension (10%), tremors (7%), and nephrotoxicity (13%). No significant changes in serum creatinine levels were observed. CONCLUSION CSA represents a helpful second-choice treatment for patients with active SLE. Administration of CSA necessitates expert and careful followup of patients.

[1]  P. Tugwell,et al.  Combination therapy with cyclosporine and methotrexate in severe rheumatoid arthritis. The Methotrexate-Cyclosporine Combination Study Group. , 1995, The New England journal of medicine.

[2]  J. Takahara,et al.  Effect of low-dose cyclosporin A on systemic lupus erythematosus disease activity. , 1994, Arthritis and rheumatism.

[3]  O. Førre.  Radiologic evidence of disease modification in rheumatoid arthritis patients treated with cyclosporine. Results of a 48-week multicenter study comparing low-dose cyclosporine with placebo. Norwegian Arthritis Study Group. , 1994, Arthritis and rheumatism.

[4]  B. Dijkmans,et al.  A randomized, double-blind, 24-week controlled study of low-dose cyclosporine versus chloroquine for early rheumatoid arthritis. , 1994, Arthritis and rheumatism.

[5]  Y. Shoenfeld,et al.  The effect of cyclosporin A on early and late stages of experimental lupus. , 1992, Arthritis and rheumatism.

[6]  Frey Fj.  Cyclosporin in autoimmune diseases , 1990 .

[7]  L. Bonomo,et al.  Clinical effects of cyclosporin in dermatomyositis , 1990, Clincal and Experimental Dermatology.

[8]  M. Liang,et al.  Reliability and validity of six systems for the clinical assessment of disease activity in systemic lupus erythematosus. , 1989, Arthritis and rheumatism.

[9]  M. Mihatsch,et al.  Factors associated with early remission of type I diabetes in children treated with cyclosporine. , 1988, The New England journal of medicine.

[10]  L. Chatenoud,et al.  Effects of cyclosporine in severe systemic lupus erythematosus. , 1987, The Journal of pediatrics.

[11]  A. Steinberg,et al.  CS-A therapy in MRL-lpr/lpr mice: amelioration of immunopathology despite autoantibody production. , 1987, Journal of immunology.

[12]  T. Waldmann,et al.  Cyclosporin A inhibits T-cell growth factor gene expression at the level of mRNA transcription. , 1984, Proceedings of the National Academy of Sciences of the United States of America.

[13]  L. Noel,et al.  Marked reduction of DNA antibody production and glomerulopathy in thymulin (FTS-Zn) or cyclosporin A treated (NZB X NZW) F1 mice. , 1983, Clinical and experimental immunology.

[14]  J. Vilček,et al.  Gamma interferon synthesis by human thymocytes and T lymphocytes inhibited by cyclosporin A. , 1983, Science.

[15]  J F Fries,et al.  The 1982 revised criteria for the classification of systemic lupus erythematosus. , 1982, Arthritis and rheumatism.

[16]  P. Lachenbruch,et al.  Cyclosporine in systemic sclerosis. Results of a forty-eight-week open safety study in ten patients. , 1993, Arthritis and rheumatism.

[17]  H. Favre,et al.  Ciclosporin in the treatment of lupus nephritis. , 1989, American journal of nephrology.

[18]  R. Schindler.  Ciclosporin in Autoimmune Diseases , 1985, Springer Berlin Heidelberg.

[19]  R. Palacios.  Cyclosporin A inhibits antigen‐ and lectin‐induced but not constitutive production of interleukin 3 , 1985, European journal of immunology.