B. Dijkmans et A. Gerards, Cyclosporin in rheumatoid arthritis - Monitoring for adverse effects and clinically significant drug interactions, BIODRUGS, 10(6), 1998, pp. 437-445
While cyclosporin has an established role in the treatment of rheumatoid ar
thritis there is concern about adverse effects, mainly related to renal fun
ction. With new interest being generated in cyclosporin combination therapy
, and the availability of a new form of cyclosporin (cyclosporin microemuls
ion), focus on adverse effects and drug interactions of this compound remai
ns important.
Over the years, rheumatologists have been aware of these adverse effects an
d consensus meetings have resulted in guidelines for the use of cyclosporin
, If these guidelines are followed, structural renal damage can be minimal,
Cyclosporin should be started at a low dose and titrated against the highe
st acceptable increase in serum creatinine, that is, a 30% increase over th
e pretreatment value. At present, there is no evidence that cyclosporin in
combination with other antirheumatics leads to increased toxicity, With reg
ard to long term unwanted effects, neither the pattern nor the risk of mali
gnancies associated with the use of cyclosporin seems to differ from other
antirheumatics.
The place of cyclosporin in the treatment of rheumatoid arthritis seems to
be established. The most promising results will come from early rheumatoid
arthritis combination studies involving cyclosporin with other antirheumati
cs, especially methotrexate.