Treatment with cyclosporin switching to hydroxychloroquine in patients with rheumatoid arthritis

Objective-To investigate the therapeutic benefit of cyclosporin A (CSA) swi tching to hydroxychloroquine (HCQ) in patients with rheumatoid arthritis (R A). Methods-Thirty four patients with RA who displayed residual inflammation an d disability despite partial responses to prior maximal tolerated doses of methotrexate, were included. AU were treated with a staged approach using C SA for 24 weeks to induce clinical improvement, followed by HCQ for 16 week s to maintain the improvement. Seven ACR core set measures were evaluated e very four to eight weeks. Results-During a 40 week open trial, 27/34 patients completed the study. CS A treatment significantly reduced the tender joints score, swollen joints s core, visual analogue pain scale, patient's or doctor's global assessment, patient's self assessed disability, and C reactive protein. Compared with t he time of entry into the trial, patients who switched from CSA to HCQ stil l possessed significantly lower levels of most variables, determined at 28, 32, and 40 weeks. According to the ACR 20% improvement definition, 15/27 ( 56%) patients had improved at 24 weeks after CSA treatment, and 14/27 (52%) remained improved at 16 weeks after the change to HCQ. Frequent side effec ts, such as hypertrichosis, gastrointestinal trouble, and hypertension, wer e noted during CSA treatment, but most of these disappeared after switching to HCQ. The mean levels of blood pressure and serum creatinine were signif icantly increased during CSA treatment, but returned to normal after changi ng to HCQ. Conclusions-The data suggest that CSA switching to HCQ treatment may be an effective strategy for patients with RA partially responding to methotrexat e, particularly those with toxicity due to CSA.