A study of the longterm efficacy and toxicity of cyclosporine A in rheumatoid arthritis.
We determined the longterm efficacy and toxicity of cyclosporine A in rheumatoid arthritis (RA) in an open clinical trial, at a single centre, outpatient rheumatology clinic. The initial dose was 5 mg/kg/day increased to 10 mg/kg/day with adjustments for toxicity and plasma cyclosporine A levels. We measured efficacy by the Ritchie articular index, pain and function on a 10 cm visual analog scale, C-reactive protein (CRP) and erythrocyte sedimentation rate. Toxicity was evaluated by patient reports, serum creatinine, cyclosporine A levels and liver function tests. Median treatment duration was 29 months (16.5-38). At 24 months median reduction in Ritchie articular index was 50% (9-79); pain: 49% (21-77), with a 50% (4-76) improvement in function; and CRP fell by 72.5% (22-87). The main side effect was a 40% (27-47) decline in estimated creatinine clearance. We conclude that cyclosporine A at doses below 5 mg/kg/day is associated with clinically significant improvements in indices of disease activity in RA. Renal dysfunction was the most frequent side effect.
Madhok
R
R
Centre for Rheumatic Diseases, University Department of Medicine, Glasgow Royal Infirmary, Scotland.
Torley
H I
HI
Capell
H A
HA
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology; D001799:Blood Sedimentation; D003401:Creatine / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects* / Q000097:blood / Q000592:standards*; D006801:Humans; D007668:Kidney / Q000502:physiology; D008099:Liver / Q000502:physiology; D008875:Middle Aged; D010147:Pain Measurement; D013997:Time Factors
D016572:Cyclosporine; D003401:Creatine