DESCRIPTION OF BLOOD-PRESSURE CHANGES IN PATIENTS BEGINNING CYCLOSPORINE-A THERAPY

Cyclosporin A (CyA) is the primary immunosuppressive agent for the pro phylaxis of rejection episodes in renal, cardiac, liver, and other tra nsplants. Recently, its use in autoimmune diseases has been investigat ed as well, Although several studies have produced promising results, nephrotoxicity and hypertension can result from CyA treatment, and the ir development must be understood in order to facilitate patient manag ement, This article describes the diastolic blood pressure (DBP) respo nses in two populations of patients during three months of CyA therapy . Study A involved psoriasis patients and Study B involved postoperati ve renal transplant patients. The relationship between blood pressure and systemic CyA exposure and other covariates was evaluated using lin ear mixed effects modeling. Temporal patterns of blood pressure change s with varying duration of CyA exposure were investigated. In Study A, the psoriasis patients showed transient exposure-related increases in DBP on CyA. These elevations, while statistically significant, were c linically insignificant. In Study B, the renal transplant patients sho wed no CyA-related rises in DBP. In neither study was there evidence f or a difference in effect on DBP between Sandimmune and Neoral, the tw o formulations of CyA presently approved for marketing by the Food and Drug Administration, after differences in CyA exposure were taken int o account.