[Successful treatment of primary biliary cirrhosis with cyclosporin]

Four patients (aged 35, 52, 53 and 62 years) with primary biliary cirrhosis (raised levels of gamma-GT, alkaline phosphatase and immunoglobulins, as well as of antimitochondrial antibodies) were treated with cyclosporine and methylprednisolone. Different from the regimen for immunosuppressive treatment after organ transplantation, the dosage of cyclosporine was set not according to whole-blood levels but individualized to variations in serum transaminases. An initial dose of 2-2.5 mg/kg proved to be optimal. Higher doses caused a rise in liver enzymes or bilirubin, because of toxic effects produced by the cyclosporine, which is predominantly metabolized in the liver. Optimal initial doses correlated positively with serum IgG levels. In all patients there was an improvement not only in the abnormally high levels of liver enzymes but also in their general condition. There was a marked fall in antimitochondrial antibody titres and immunoglobulin values. These findings indicate that treatment of primary biliary cirrhosis with low doses of cyclosporine and methylprednisolone is effective and low in side effects and can arrest the progression of the disease even in an advanced stage.