US consensus guidelines for the use of cyclosporin a in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that o ften leads to irreversible joint damage and loss of function. Although ther e are numerous treatment options, it is difficult to manage the disease in most patients. Use of cyclosporin A (CsA) for RE was first reported in 1979 , and since that time many trials have investigated CsA use for this diseas e. Based on clinical evidence, CsA is an efficacious second-line agent for patients with active RA who have not responded adequately to methotrexate ( MTX). In addition, CsA has been shown to provide clinical benefit when used in combination with MTX in patients responding inadequately to MTX monothe rapy. Side effects associated with CsA treatment are manageable if dosing, monitoring, and intervention guidelines are followed. The purpose of this r eview is to provide recommendations for the use of CsA in severe RA to phys icians experienced in the management of systemic immunosuppressive therapy for RA. Where possible and appropriate, recommendations are based on eviden ce available in the literature.