Safety aspects of the long term cyclosporin A therapy

The long term safety issues of cyclosporin A therapy of rheumatoid arthritis can be classified into two categories: side effects typical for the cyclosporin group of drugs and side effects due to the immunosuppression. A decrease in the renal function and elevation of the blood pressure are the main cyclosporin-related side effects. Blood pressure can be controlled in most cases by dose reduction or by antihypertensive therapy. With the current low dose strategy, a mild decrease of renal function is common but the incidence of permanent renal damage is low and the prognosis is good. Immunosuppression as such may predispose for malignancies and infections. Cyclosporin A is not mutagenic. However, it may impair the immunosurveillance for transformed cells. Data from organ transplantation suggest that immunosuppressive regimens including cyclosporin A increase the incidence of lymphoproliferative disorders and skin cancers. It is not clear whether cyclosporin A can increase the incidence of these tumors in patients with rheumatoid arthritis due to a relatively small number of patients studied thus far. Monitoring of cyclosporin A therapy of rheumatoid arthritis is simple but mandatory.