Late-Onset Scleroderma Renal Crisis Induced by Tacrolimus and Prednisolone

Nunokawa, Takahiro; Akazawa, Masanobu; Yokogawa, Naoto; Shimada, Kota; Hiramatsu, Kazuko; Nishio, Yasuhide; Suzuki, Shoji

doi:10.1097/mjt.0b013e3182583ba1

Cited by 11 publications

(11 citation statements)

References 14 publications

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“… 24 Finally, 27 review articles were excluded, and the remaining 37 identified primary research articles were included into the analysis. 24 – 60 The 37 articles consisted of 19 case reports, 15 case series, 1 open-label, randomized controlled trial with a no-treatment arm (group I iloprost vs group II iloprost with low-dose CsA), one open-label, prospective study with a historical control group (CSA group vs historical placebo group of the chlorambucil trial), 61 and one retrospective study without control (patients received prednisolone (0.5 mg/kg/d) and tacrolimus; Table 1 ).…”

Section: Results Of the Systematic Literature Searchmentioning

confidence: 99%

Calcineurin inhibitors in systemic sclerosis – a systematic literature review

Hofmann

Ambühl

Jordan

et al. 2022

Therapeutic Advances in Musculoskeletal

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Objective: To review treatment effectiveness and adverse events of calcineurin inhibitors (CNIs) such as cyclosporin A (CsA) and tacrolimus in patients with systemic sclerosis (SSc). Methods: A systematic literature search was performed on PubMed and Web of Science using the predefined keywords ‘systemic sclerosis’, scleroderma, cyclosporin*, and tacrolimus. Articles were eligible for inclusion, if SSc patients had been treated with CNIs and data on treatment effects were available. Results: This systematic literature review identified 37 papers (19 case reports, 15 case series, 2 controlled studies, and 1 retrospective study) including 134 SSc patients treated with CNIs. In 34 of 37 papers, CsA was used. An improvement of skin fibrosis was observed in 77 of 96 (80.2%) patients using a wide variety of outcome measures and dose regimes. Both controlled studies showed significant improvements, one using a historical control group and one using a no-treatment control group. Improvement in pulmonary function tests (PFTs) occurred in 67.9% (19/28) of the patients who had reduced PFTs at baseline. In 58 (43.3%) cases, adverse renal events were reported, of which 7 (5.2%) were severe such as scleroderma renal crisis (SRC), CsA-associated nephropathy, or death by renal insufficiency. Adverse events led to dose reduction, treatment interruption, or withdrawal in 39 of 134 (29.1%). Conclusion: In this systematic literature review, signals for potential effectiveness of CsA for skin and pulmonary fibrosis were found, but the evidence level of the identified studies was too low to allow robust conclusions. Randomized controlled double-blind trials are needed to conclude on the effectiveness of CNIs in SSc. Renal toxicity of CNIs was confirmed in this review and needs to be considered in the design of such studies.

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Section: Results Of the Systematic Literature Searchmentioning

confidence: 99%

Calcineurin inhibitors in systemic sclerosis – a systematic literature review

Hofmann

Ambühl

Jordan

et al. 2022

Therapeutic Advances in Musculoskeletal

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“…A retrospective report on patients with ILD associated with connective tissue disease, in which the patients were administrated cyclosporin, reported that one of four patients with SSc‐ILD died, one experienced a transitory effect and the remaining two had no progression of disease 156 . However, calcineurin inhibitors potentially induce a renal crisis, 157,158 and their use should be avoided in patients at high risk of developing renal crisis, such as those with early dcSSc. There are few reports on the efficacy of calcineurin inhibitors; therefore, from a risk–benefit perspective, it is not recommended to use them as a first‐line therapy for treating patients with SSc‐ILD.…”

Section: Guidelines For the Treatment Of The Lungsmentioning

confidence: 99%

Diagnostic criteria, severity classification and guidelines of systemic sclerosis

Asano

Jinnin

Kawaguchi

et al. 2018

The Journal of Dermatology

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Several effective drugs have been identified for the treatment of systemic sclerosis (SSc). However, in advanced cases, not only their effectiveness is reduced but they may be also harmful due to their side-effects. Therefore, early diagnosis and early treatment is most important for the treatment of SSc. We established diagnostic criteria for SSc in 2003 and early diagnostic criteria for SSc in 2011, for the purpose of developing evaluation of each organ in SSc. Moreover, in November 2013, the American College of Rheumatology and the European Rheumatology Association jointly developed new diagnostic criteria for increasing their sensitivity and specificity, so we revised our diagnostic criteria and severity classification of SSc. Furthermore, we have revised the clinical guideline based on the newest evidence. In particular, the clinical guideline was established by clinical questions based on evidence-based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of SSc.

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“…It is known that chronic use of calcineurin inhibitors is marred by several side effects among vascular toxicity. Among them, cyclosporine and tacrolimus, which cause vasospasm, have been associated with SRC (33) and increase the production of proinflammatory cytokines and endothelial activation markers both in vivo and ex vivo (34).…”

Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

“…Corticosteroids (CS) are capable of inhibiting prostacyclin production and increasing ACE activity, and this could contribute to the pathogenesis of SRC. As of today, in vitro studies that evaluate the mechanism underlying the effects of the use of CS on the effector cells involved in the vascular damage observed in SRC are still lacking; whereas the use of CS as a potent risk factor in the development of SRC has been evaluated by Steen and Medsger (35) in their retrospective case-control study and in several case reports and a systematic review (33, 36-38).…”

Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

Kidney involvement in systemic sclerosis: From pathogenesis to treatment

Bruni

Cuomo

Rossi

et al. 2018

Journal of Scleroderma and Related Disorders

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Among all possible systemic sclerosis internal organ complications, kidney involvement is frequently neglected or underestimated, except for the life-threatening scleroderma renal crisis. Fortunately, this severe clinical presentation is nowadays better controlled with available treatments, in particular angiotensin-converting enzyme inhibitors, and this has led to a reduction in its short-and longer-term mortality. Pathogenetic determinants are not well understood and many different other kidney involvements are possible in systemic sclerosis, including proteinuria, albuminuria, reduction of renal filtration, autoantibodies-related glomerulonephritis, and drug-related side effects. Different serological and radiological methods of evaluations are nowadays available, some representing promising diagnostic tool and prognostic outcome measure. Except for angiotensin-converting enzyme inhibitors in scleroderma renal crisis, no other treatment is currently recommended for treatment of kidney involvement in systemic sclerosis. For this reason, further studies are necessary to investigate its prognostic impact, in particular in combination with other systemic sclerosis-related internal organ manifestations. This review summarizes current available literature on kidney involvement in systemic sclerosis.

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Late-Onset Scleroderma Renal Crisis Induced by Tacrolimus and Prednisolone

Cited by 11 publications

References 14 publications

Calcineurin inhibitors in systemic sclerosis – a systematic literature review

Calcineurin inhibitors in systemic sclerosis – a systematic literature review

Diagnostic criteria, severity classification and guidelines of systemic sclerosis

Kidney involvement in systemic sclerosis: From pathogenesis to treatment

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