An audit of cyclosporin for systemic lupus erythematosus and related overlap syndromes: limitations of its use

Objective-To establish the usefulness of cyclosporin for systemic lupus ery thematosus (SLE) in a routine clinical setting. Methods-Patients who had received cyclosporin for SLE, mixed connective tis sue disease, and other overlap syndromes were identified. Data relating to treatment with cyclosporin, including dosage, concurrent steroid use, respo nse to treatment, side effects, and reasons for withdrawal, were extracted from medical notes. Results-A total of 43 patients had been treated with cyclosporin between 19 95 and 1998. Cyclosporin, average dose 4 mg/kg/d, was started in patients w hose disease was active despite previous use of alternative second line age nts. On every occasion when cyclosporin was used for thrombocytopenia the r esponse was good, but when arthritis was the indication, the response was g ood in 14/26. The success rates for symptoms of arthralgia, myalgia, and fa tigue were lower. Side effects occurred in 28/43 (65%) cases, and on 39/47 (83%) occasions cyclosporin was withdrawn owing to either side effects or f ailure to control disease activity, after a median duration of treatment of only four months. Conclusions-The response to cyclosporin is mixed and usually short lived.