Cyclosporin and tacrolimus: their use in a routine clinical setting for scleroderma

Background. Cyclosporin and tacrolimus are immunomodulatory drugs which act predominantly on T cells. Improvements in certain manifestations, particul arly skin tightness, have been observed in a number of patients with sclero derma treated with these drugs. However, to date there have been no reports of their use in a routine clinical setting. Methods. Patients attending clinical immunology clinics who had progressive systemic sclerosis and related syndromes and who had received cyclosporin and/or tacrolimus were identified. Details of their treatment, including dr ug dosage, duration of and response to treatment, side-effects and reasons for withdrawal, were recorded. Results. Sixteen patients had been given cyclosporin and 13 of these had be en treated for skin tightness. Half noticed significant softening of their skin whilst on treatment, and resolution was observed in all four of the pa tients treated for digital vasculitis. Side-effects were common and dose-li miting, and contributed to withdrawal in 12 out of 13 patients. Eight patie nts had been treated with tacrolimus; two of these had stopped the drug bec ause of progression of their disease, one developed diarrhoea, prompting wi thdrawal, one stopped tacrolimus following improvement, and four remained o n the drug. Side-effects had occurred in three patients. Conclusion. Improvements in skin occur in approximately half of all cases o f scleroderma treated with either cyclosporin or tacrolimus, suggesting a b eneficial effect. Side-effects, especially hypertension, are common with cy closporin and often necessitate withdrawal. Adverse effects are also observ ed with tacrolimus, but in the small cohort so far treated only one patient had stopped the drug for this reason.