Drug combination therapy of systemic lupus erythematosus

Miescher, P. A.; Favre, H; Lemoine, Robert; Huang, You-Peng

doi:10.1007/978-3-642-79622-7_11

Cited by 5 publications

(5 citation statements)

References 13 publications

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“…The earliest experience with CyA treatment in patients with systemic lupus erythematosus (SLE) dates back to 1981; nowadays, CyA is not so commonly prescribed to lupus patients. In several small observational studies, CyA, alone or in combination with other agents, has been shown to reduce disease activity and improve immunological parameters such as anti-dsDNA titers and complement levels, allowing steroid tapering [61][62][63][64][65][66][67][68][69] (Table 3). In particular, CyA has been shown to be beneficial in some lupus manifestations, and it might be taken into account as therapeutic option in refractory lupus nephritis, skin disease and haematological involvement [70].…”

Section: Cyclosporine a In Systemic Lupus Erythematosusmentioning

confidence: 99%

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

Chighizola

Ong

Meroni

2016

Clinic Rev Allerg Immunol

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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.

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Section: Cyclosporine a In Systemic Lupus Erythematosusmentioning

confidence: 99%

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

Chighizola

Ong

Meroni

2016

Clinic Rev Allerg Immunol

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“…Different immunosuppressant drugs can be implemented to control disease activity depending on the severity of and type of organ damage, particularly, nephritic versus neurological. Hydroxicloroquine (HYQ) and low dose of CCS are commonly effective in patients with mild SLE, whereas a mono or combined therapy of: azathioprine, methotrexate (MTX), mycophenolate mofetil and cyclophosphamide with high doses of CCS are used in active, severe or refractorySLE [ 47 , 48 ]. Cyclosporine (CsA) has been introduced in 1981 by Isenberg et al [ 49 ] for patients with active SLE; 2.5–5 mg/kg/day may provide adequate disease control and behave as CCS-sparing drug [ 50 ].…”

Section: Therapeutic Management and Drug Resistance In Systemic Lupusmentioning

confidence: 99%

P-Glycoprotein and Drug Resistance in Systemic Autoimmune Diseases

Picchianti-Diamanti

Rosado

Scarsella

et al. 2014

IJMS

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Autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic inflammatory disorders of unknown etiology characterized by a wide range of abnormalities of the immune system that may compromise the function of several organs, such as kidney, heart, joints, brain and skin. Corticosteroids (CCS), synthetic and biologic immunosuppressive agents have demonstrated the capacity to improve the course of autoimmune diseases. However, a significant number of patients do not respond or develop resistance to these therapies over time. P-glycoprotein (P-gp) is a transmembrane protein that pumps several drugs out of the cell, including CCS and immunosuppressants; thus, its over-expression or hyper-function has been proposed as a possible mechanism of drug resistance in patients with autoimmune disorders. Recently, different authors have demonstrated that P-gp inhibitors, such as cyclosporine A (CsA) and its analogue Tacrolimus, are able to reduce P-gp expression and or function in SLE, RA and PsA patients. These observations suggest that P-gp antagonists could be adopted to revert drug resistance and improve disease outcome. The complex inter-relationship among drug resistance, P-gp expression and autoimmunity still remains elusive.

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“…44 Miescher et al reported their long-term outcome with the use of cyclosporin A and corticosteroids and the addition of cyclophosphamide IV pulses and parenteral methotrexate in severe cases of SLE. 45 Over an average observation period of 7 y, 19 patients had suf®cient control of their disease with corticosteroids and cyclosporin A, 24 had the addition of IM or IV methotrexate and 30 received quadruple combination therapy with corticosteroids, cyclosporin A, methotrexate and cyclophosphamide. The latter group, in particular, included patients with severe lupus nephropathy.…”

Section: Combination Therapymentioning

confidence: 99%

The treatment of lupus with cyclosporin A

Griffiths

Emery

2001

Lupus

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Cyclosporin is a potent immunosuppressive drug and is frequently used in the therapy of autoimmune diseases, including systemic lupus erythematosus (SLE). Few large studies have been performed using this drug in SLE patients. However, small uncontrolled studies of patients with SLE have shown favourable results with a significant improvement in disease activity, a fall in anti ds DNA titres and proteinuria and an improvement in complement levels, leucopaenia and thrombocytopaenia. Interestingly, a consistent reduction in corticosteroid dosage often by as much as 50% is seen. Toxicity, especially with hypertension and renal impairment, occurs but usually reverses on dose reduction or the addition of an anti-hypertensive agent and is minimised by adherence to the strict monitoring guidelines. Large multi-centre randomised-controlled trials of the use of cyclosporin in SLE patients are underway and the results are eagerly awaited.

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Drug combination therapy of systemic lupus erythematosus

Cited by 5 publications

References 13 publications

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

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

P-Glycoprotein and Drug Resistance in Systemic Autoimmune Diseases

The treatment of lupus with cyclosporin A

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