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Long-term treatment of systemic lupus erythematosus with cyclosporin A
D Caccavo1, B Laganà, A P Mitterhofer
1University La Sapienza, Rome, Italy.
Insights
Long-term cyclosporin A (CSA) treatment effectively reduces disease activity in patients with systemic lupus erythematosus (SLE). This immunosuppressive therapy offers a significant steroid-sparing effect, but requires careful patient monitoring.
Area of Science:
- Immunology
- Rheumatology
- Pharmacology
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by widespread inflammation.
- Standard treatments for SLE, including steroids and cytotoxic drugs, can have significant side effects and may not be effective for all patients.
Purpose of the Study:
- To assess the long-term efficacy and safety of cyclosporin A (CSA) as a treatment for active systemic lupus erythematosus (SLE).
Main Methods:
- A prospective, nonrandomized study involving 30 patients with SLE resistant to conventional therapies.
- Exclusion criteria included hypertension and hypercreatinemia.
- Disease activity was measured using the systemic lupus activity measure at baseline and at 6, 12, 18, and 24 months.
Main Results:
- Twenty-seven patients completed 24 months of CSA treatment.
- A significant reduction in disease activity scores was observed by 6 months and maintained throughout the study (P < 0.01).
- A notable steroid-sparing effect was achieved (P < 0.01), with common side effects including hypertrichosis, paresthesias, and gastrointestinal issues. Nephrotoxicity occurred in 13% of patients, with no significant changes in serum creatinine.
Conclusions:
- Cyclosporin A (CSA) is a valuable second-line treatment option for patients with active systemic lupus erythematosus (SLE).
- Careful and expert patient follow-up is essential during CSA therapy due to potential side effects.
Objective:
To evaluate the efficacy of long-term treatment with cyclosporin A (CSA) in systemic lupus erythematosus (SLE).
Methods:
Thirty patients with SLE whose condition was either poorly responsive or unresponsive to treatment with steroids and/or cytotoxic drugs were enrolled in a prospective, nonrandomized study of CSA. Patients with hypertension or hypercreatinemia were excluded. Disease activity was evaluated according to the systemic lupus activity measure. Assessments were made prior to study entry and after 6, 12, 18, and 24 months.
Results:
Twenty-seven patients completed at least 24 months of treatment with CSA. The mean disease activity score significantly decreased after 6 months of therapy (P < 0.01); this result was maintained throughout the study. A conspicuous steroid-sparing effect was observed following administration of CSA (P < 0.01). Side effects included hypertrichosis (63% of patients), paresthesias (23%), gastrointestinal symptoms (20%), gingival hyperplasia (17%), hypertension (10%), tremors (7%), and nephrotoxicity (13%). No significant changes in serum creatinine levels were observed.
Conclusion:
CSA represents a helpful second-choice treatment for patients with active SLE. Administration of CSA necessitates expert and careful followup of patients.