title: The Use of Cyclosporine A in Rheumatology: a 2016 Comprehensive Review.
abstract: Cyclosporine A, an inhibitor of calcineurin, exerts an immunomodulator action interfering with T cell activation. Even though novel therapeutic tools have emerged, CyA still represents a suitable option in several clinical rheumatology settings. This is the case of refractory nephritis and cytopenias associated with systemic lupus erythematosus. Furthermore, CyA is a valued therapeutic tool in the management of uveitis and thrombophlebitis in course of Behçet's disease. Topical CyA has been proven to be beneficial in the dry eye of Sjogren's syndrome, whereas oral treatment with CyA can be considered for the severe complications of adult onset Still's disease. CyA provides a therapeutic option in psoriatic arthritis, being rather effective in skin disease. CyA is currently regarded as a second-line option for patients with inflammatory myopathies refractory to standard regimen. CyA is used even in paediatric rheumatology, in particular in the management of juvenile dermatomyositis and macrophage activation syndrome associated with systemic juvenile idiopathic arthritis. Importantly, CyA has been shown to suppress the replication of HCV, and it can thus be safely prescribed to those patients with chronic hepatitis C. Noteworthy, CyA can be administered throughout the gestation course. Surely, caution should be paid to CyA safety profile, in particular to its nephrotoxicity. Even though most evidence comes from small and uncontrolled studies with few randomised controlled trials, CyA should be still regarded as a valid therapeutic tool in 2016 rheumatology.
authors: Allergology, Clinical Immunology and Rheumatology Unit, IRCCS Istituto Auxologico Italiano, piazzale Brescia 20, 20149, Milan, Italy.|Experimental laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095, Cusano Milanino, Milan, Italy.|Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
authors: Cecilia Beatrice
authors: CB
authors: Chighizola
authors: Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK.
authors: Voon H
authors: VH
authors: Ong
authors: Experimental laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095, Cusano Milanino, Milan, Italy. pierluigi.meroni@unimi.it.|Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy. pierluigi.meroni@unimi.it.|Division of Rheumatology, ASST G. Pini, Pzza C Ferrari 1, 20122, Milan, Italy. pierluigi.meroni@unimi.it.
authors: Pier Luigi
authors: PL
authors: Meroni
mesh_terms: D000328:Adult; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D001528:Behcet Syndrome / Q000188:drug therapy*; D002648:Child; D016572:Cyclosporine / Q000627:therapeutic use*; D016174:Hepacivirus / Q000502:physiology*; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008213:Lymphocyte Activation / Q000187:drug effects; D012219:Rheumatology / Q000639:trends; D012859:Sjogren's Syndrome / Q000188:drug therapy*; D016706:Still's Disease, Adult-Onset / Q000188:drug therapy*; D013601:T-Lymphocytes / Q000187:drug effects* / Q000276:immunology; D014779:Virus Replication
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine
keywords: Arthritides; Connective tissue diseases; Cyclosporine; Hepatitis C virus; Rheumatology; Vasculitides