LIFE-TABLE ANALYSIS OF CYCLOSPORINE-A TREATMENT IN PSORIATIC-ARTHRITIS - COMPARISON WITH OTHER DISEASE-MODIFYING ANTIRHEUMATIC DRUGS

Objectives. The aim of this study was to determine the cumulative prob ability of taking CsA in comparison to other DMARDs, as well as the re ason for discontinuation of each DMARD, in a large cohort of PsA patie nts. Methods. We prospectively studied 172 consecutive patients with a diagnosis of PsA who had been admitted to our rheumatological unit si nce 1984. We collected information about treatment with DMARDs includi ng: number dose, duration and causes of withdrawal, including side eff ects or inefficacy. Cumulative survival analysis was performed by the Kaplan-Meier test and the differences between these survival curves we re determined by the Mantel-Hanszel test. Results. The probability cur ve of continuing to take CsA was significantly lower than that of MTX (p < 0.046). The rate of adverse effects responsible for stopping DMAR D therapy was higher in the CsA group, especially with respect to the antimalarial group (p < 0.014). The most common cause of CsA withdrawa l was hypertension. The rate of withdrawal due to inefficacy in the Cs A group was not significantly different from those observed in the oth er groups. Nevertheless, the total frequency of discontinuation due to toxicity and inefficacy in the MIX group was significantly lower comp ared to the gold salts (p < 0.05) and CsA groups (p < 0.01). Conclusio ns. Life-table analysis suggests that PsA patients taking CsA are less likely than patients on MTX to continue long term treatment. Therefor e CsA, which seems to be less safe than the antimalarials, could be co nsidered a useful drug in the treatment of PsA, but does not seem to r epresent the drug of first choice, particularly when compared to MTX.