[Use of cyclosporin A in chronic polyarthritis and other rheumatic diseases]

Cyclosporin A (CyA), a well-established drug in human transplantation for more than 10 years, has been used as an experimental treatment in autoimmune diseases increasingly since 1985. Its efficacy in rheumatoid arthritis (RA) and psoriasis/psoriatic arthritis has been demonstrated in numerous placebo-controlled studies. In RA is seems to be equal to azathioprine and D-penicillamine. CyA may also be of considerable benefit in other systemic diseases like polymyositis and primary biliary cirrhosis. The risk of side-effects, mainly nephrotoxicity has led to dosage guidelines, including a starting dose between 2.5 and 3.5 mg/kg/day and an upper dose limit of 5 mg/kg as well as dose reduction if serum creatinine is persistently raised by more than 30% of pre-treatment values. In the future, CyA may be an ideal partner for drug combinations because of its well-defined mechanism of action (inhibition of lymphokine-, especially interleukin-2-production) and possibly the low-dose sufficient for efficacy in combination. Studies relating to this are on-going.