Sandimmun(®) (ciclosporin, Cyclosporin A) Past experience and present uses in autoimmune diseases

Sandimmun (cyclosporin) is the established therapy to prevent graft rejection of all transplanted organs. The drug is also effective in several autoimmune diseases. Uveitis was the first clinical indication tested with Sandimmun systematically in the early eighties. Its use has been widely accepted particularly for the treatment of Behçet uveitis. However, in long-term use at high doses, biopsy-proven kidney deterioration in some patients led to a reduction in recommended doses. With close monitoring of renal dysfunction and a starting dose not exceeding 5 mg/kg, Sandimmun has since been shown to be effective in controlled trials in severe rheumatoid arthritis, severe psoriasis and treatment-resistant atopic dermatitis. Sandimmun has also been shown to be of benefit in patients with nephrotic syndrome, SLE and primary biliary cirrhosis among other indications. Based on extended clinical trials and numerous publications, it can be concluded that the use of Sandimmun in selected autoimmune diseases is of benefit to patients if the risks are adequately controlled by following established safety monitoring rules.