Cyclosporin in rheumatoid arthritis: a double blind, placebo controlled study in 52 patients.

Dougados, Maxime; Awada, H

doi:10.1136/ard.47.2.127

Cited by 128 publications

(44 citation statements)

References 14 publications

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“…Various randomized controlled studies have provided substantial evidence that cyclosporin A (CsA) can control t h e symptoms of active RA in both its advanced (10)(11)(12)(13)(14)(15)(16) and early stages (17). Previous studies have shown that CsA-induced nephrotoxicity and hypertension can b e handled provided that strict guidelines are followed (18).…”

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confidence: 99%

Slow progression of joint damage in early rheumatoid arthritis treated with cyclosporin a

Pasero

Priolo

Marubini

et al. 1996

Arthritis & Rheumatism

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Objective. To evaluate the ability of low‐dose cyclosporin A (CsA) to control radiologic disease progression, and to assess the clinical efficacy and tolerability of CsA, compared with conventional disease‐modifying antirheumatic drugs (DMARDs), in patients with early active rheumatoid arthritis (RA). Methods. In this long‐term, multicenter, prospective, open, blinded end point, randomized trial, 361 consenting patients with early (< 4 years since diagnosis) active RA were enrolled. Of the eligible patients, 167 were treated with CsA at 3 mg/kg/day, and 173 with DMARDs. The decision to use conventional antirheumatic drugs as controls was based on the fact that joint erosion could be expected to occur after 1 year regardless of the type of DMARD being used. The possibility of switching therapies in both groups was intended to keep the largest possible number of patients in the study. Results. Blinded evaluation of hand and foot radiographs after 12 months of treatment showed that CsA led to a significant (P < 0.001) delay in the mean ± SD progression in the eroded joint count (1.3 ± 3.1 versus 2.4 ± 3.0 for the control group) and in the joint damage score (3.6 ± 8.9 versus 6.9 ± 9.1 for the control group), both measured by the Larsen‐Dale method. When only the patients without erosion at baseline were considered (37 in the CsA‐treated group and 54 in the control group), erosion appeared in only 10.8% of the CsA‐treated patients, but in 51.8% of the controls (P = 0.00005). Low‐dose CsA was as effective as traditional DMARDs in controlling clinical symptoms. Maintenance on the initially prescribed treatment regimen (“survival on treatment”) was also better at 12 months with CsA than with DMARDs (89.2% versus 77.5%; P = 0.002). The tolerability of CsA was acceptable. Conclusion. These 12‐month results suggest that low‐dose CsA decreases the rate of further joint damage in previously involved joints as well as the rate of new joint involvement in previously uninvolved joints, in patients with early RA.

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Slow progression of joint damage in early rheumatoid arthritis treated with cyclosporin a

Pasero

Priolo

Marubini

et al. 1996

Arthritis & Rheumatism

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“…Several protocols have been suggested as alternatives to standard prednisone therapy in order to reduce toxicity of corticosteroids in these patients. They include intermittent corticotherapy [30], alternate-day 2 The following Italian renal units are participating in this trial: Nefrologia, Ospedale Maggiore, Milano (Ponticelli, Rivolta); Clinica Pediátrica, Università di Milano (Edcfonti, Ghio); Nefrologia, Ospe dale Bergamo (Mecca. Remuzzi); Nefrologia, Ospedale Lecco (Locatelli, Pozzi); Nefrologia, Università I, Napoli (Lama); Nefrologia.…”

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confidence: 99%

“…Recent studies have also shown the efficacy of CS in some autoimmune diseases, such as rheumatoid arthritis [1,2], posterior uveitis [3], insulin-dependent diabetes [4], Crohn's disease [5] and psoriasis [6,7], In the field of primary glomerulonephritis, several trials with CS have been carried out, most of them in patients with minimal-change glomerulopathy (MChG) or focal segmental glomerulosclerosis (FSGS).…”

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Ciclosporin in Minimal-Change Glomerulopathy and in Focal Segmental Glomerular Sclerosis

Ponticelli

Rivolta

1990

Am J Nephrol

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Results of the available literature and preliminary data of an ongoing multicenter, prospective, randomized Italian trial indicate that ciclosporin (CS), at low doses, may maintain remission of the nephrotic syndrome in most steroid-sensitive patients. In steroid-resistant patients CS may cause either complete or partial remission in about 40% of patients with idiopathic nephrotic syndrome. With doses not exeeding 5 mg/kg/day and careful monitoring of renal and liver function, blood pressure and blood levels, severe side effects can be prevented. Although an extensive use of CS in nephrotic syndrome is still premature, cautious trials may be attempted in patients with steroid toxicity and/or devastating nephrotic syndrome.

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“…Discussion. The efficacy of cyclosporin A in active rheumatoid arthritis has been noted, but varying degrees of renal dysfunction have been observed (1)(2)(3)(4). Nonsteroidal antiinflammatory drugs have been implicated as a possible risk factor for this toxicity.…”

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confidence: 99%

The effects of cyclosporin a on eicosanoid excretion in patients with rheumatoid arthritis

Weinblatt

Helfgott

Coblyn

et al. 1991

Arthritis & Rheumatism

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Alterations in renal eicosanoid levels have been postulated as a factor in cyclosporin A (CSA) nephrotoxicity. The effects of CSA on renal eicosanoid excretion in rheumatoid arthritis were studied over a 24-week period, during which treatment with nonsteroidal antiinflammatory drugs was discontinued. The initial dosage of CSA was 4 mglkglday; at week 24, the mean dosage of CSA was 3.9 mglkglday. At week 24, the mean (2SD) serum creatinine level (1.04 2 0.24 mg/dl) was 32% above the baseline value; renal blood flow had decreased by 21% (P < 0.03) and the glomerular filtration rate had decreased by 16%. There was a significant increase (P < 0.03) in the 2,3-dinor thromboxane B, level at week 2, but there was no significant change in the levels of the other eicosanoids. This study demonstrates that after CSA treatment, there is a selective increase in a thromboxane metabolite that parallels an increase in renal vascular resistance, even in the absence of nonsteroidal antiinflammatory drugs,

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Cyclosporin in rheumatoid arthritis: a double blind, placebo controlled study in 52 patients.

Cited by 128 publications

References 14 publications

Slow progression of joint damage in early rheumatoid arthritis treated with cyclosporin a

Slow progression of joint damage in early rheumatoid arthritis treated with cyclosporin a

Ciclosporin in Minimal-Change Glomerulopathy and in Focal Segmental Glomerular Sclerosis

The effects of cyclosporin a on eicosanoid excretion in patients with rheumatoid arthritis

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