The Use of Cyclosporine A in Rheumatology: a 2016 Comprehensive Review

Abstract

Cyclosporine A, an inhibitor of calcineurin, exerts an immunomodulator action interfering with T cell activation. Even though novel therapeutic tools have emerged, CyA still represents a suitable option in several clinical rheumatology settings. This is the case of refractory nephritis and cytopenias associated with systemic lupus erythematosus. Furthermore, CyA is a valued therapeutic tool in the management of uveitis and thrombophlebitis in course of Behçet's disease. Topical CyA has been proven to be beneficial in the dry eye of Sjogren's syndrome, whereas oral treatment with CyA can be considered for the severe complications of adult onset Still's disease. CyA provides a therapeutic option in psoriatic arthritis, being rather effective in skin disease. CyA is currently regarded as a second-line option for patients with inflammatory myopathies refractory to standard regimen. CyA is used even in paediatric rheumatology, in particular in the management of juvenile dermatomyositis and macrophage activation syndrome associated with systemic juvenile idiopathic arthritis. Importantly, CyA has been shown to suppress the replication of HCV, and it can thus be safely prescribed to those patients with chronic hepatitis C. Noteworthy, CyA can be administered throughout the gestation course. Surely, caution should be paid to CyA safety profile, in particular to its nephrotoxicity. Even though most evidence comes from small and uncontrolled studies with few randomised controlled trials, CyA should be still regarded as a valid therapeutic tool in 2016 rheumatology.

Baicalin reduces ciclosporin bioavailability by inducing intestinal p-glycoprotein in rats

“…Many renal and liver transplants need anti‐inflammatory therapy and concomitant medications . So the combination of anti‐inflammatory agents such as BG and CsA may widely use in clinical practice and the therapeutic monitoring of CsA was required to avoid underexposure, which can result in organ rejection, or excess exposure, which may cause toxic effects . Orally administered CsA undergoes absorption in the gastrointestinal tract, extensive liver metabolism and excreted in the bile .…”

“…[14] So the combination of anti-inflammatory agents such as BG and CsA may widely use in clinical practice and the therapeutic monitoring of CsA was required to avoid underexposure, which can result in organ rejection, or excess exposure, which may cause toxic effects. [15] Orally administered CsA undergoes absorption in the gastrointestinal tract, extensive liver metabolism and excreted in the bile. [16,17] The major metabolites (hydroxylated products) are catalysed by CYP3A4, and CYP3A5 only transforms the drug into Ndemethylated product.…”

Cyclosporine therapy in cytokine storm due to coronavirus disease 2019 (COVID-19)

“…Cyclosporine is a potent immunosuppressive agent and often uses for immunosuppression after organ transplantation. It is widely used in the treatment of vasculitis by rheumatologists [3]. Cyclosporine can be used in the treatments of Behçet's disease, psoriatic arthritis, and lupus nephritis [3].…”

“…It is widely used in the treatment of vasculitis by rheumatologists [3]. Cyclosporine can be used in the treatments of Behçet's disease, psoriatic arthritis, and lupus nephritis [3]. Nowadays, it is not used for the treatment of rheumatoid arthritis [3].…”

“…Cyclosporine can be used in the treatments of Behçet's disease, psoriatic arthritis, and lupus nephritis [3]. Nowadays, it is not used for the treatment of rheumatoid arthritis [3]. Serious side effects of cyclosporine have limited its use.…”