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[Cyclosporin and autoimmune diseases. 2: Human autoimmune diseases]
Abstract:
The effectiveness of cyclosporin against human auto-immune diseases has been well established in uveitis, rheumatoid arthritis and insulin-dependent diabetes. No firm conclusion can be drawn from trials conducted in other diseases, since the results are discordant or based on an insufficient number of subjects. In view of the side-effects, and notably the risk of nephrotoxicity, of the drug, the blood levels of cyclosporine must be measured and the patient's renal function evaluated at regular intervals. For the time being, these risks reduce the prescription of cyclosporin to the severe forms of autoimmune diseases, i.e. those which resist conventional corticosteroid therapy. Things are different with diabetes, since cyclosporin is the only immunosuppressant which has proved effective in inducing remissions. But whether such remissions can be maintained in the long term remains uncertain, and this type of treatment is still limited to therapeutic trials.
Insights
Cyclosporin effectively treats severe autoimmune diseases like uveitis and rheumatoid arthritis. While it induces diabetes remissions, long-term efficacy and risks like nephrotoxicity require careful monitoring.
Area of Science:
- Immunology
- Pharmacology
- Nephrology
Background:
- Cyclosporin's efficacy is established for uveitis, rheumatoid arthritis, and insulin-dependent diabetes.
- Results in other autoimmune diseases are inconclusive due to discordant data or small sample sizes.
Purpose of the Study:
- To review the established and potential applications of cyclosporin in autoimmune diseases.
- To highlight the risks associated with cyclosporin therapy, including nephrotoxicity.
- To discuss the current limitations and future directions for cyclosporin use.
Main Methods:
- Review of clinical trial data and established therapeutic uses of cyclosporin.
- Analysis of side-effect profiles, focusing on nephrotoxicity.
- Evaluation of cyclosporin's role in managing severe autoimmune conditions and diabetes.
Main Results:
- Cyclosporin is effective in severe autoimmune diseases resistant to corticosteroids.
- It is the only immunosuppressant shown to induce remissions in diabetes.
- Concerns regarding nephrotoxicity necessitate regular monitoring of blood levels and renal function.
Conclusions:
- Cyclosporin is a valuable treatment for specific severe autoimmune diseases.
- Its use in diabetes shows promise for inducing remissions, but long-term maintenance is uncertain.
- Careful patient selection and monitoring are crucial due to potential side effects.