Neoral--new cyclosporin for old?

Autor: M. F. Somerville, D. G. I. Scott
Rok vydání: 1997
Předmět:
Zdroj: Rheumatology. 36:1113-1115
ISSN: 1462-0332
1462-0324
DOI: 10.1093/rheumatology/36.10.1113
Popis: SUMMARY Cyclosporin A is now well established as an eAective second-line drug to treat rheumatoid arthritis. In April 1995, the microemulsion-based formulation of cyclosporin (Neoral) was introduced based on its increased bioavailability at ‘no extra cost’. There may have been concerns that with increased bioavailability of Neoral, some patients might experience increased toxicity, particularly if transferring from Sandimmun to Neoral at the same dose. We describe our experience of 51 patients treated with Neoral—39 with rheumatoid arthritis, six with psoriatic arthritis and the remainder with a variety of diseases, including Behc∞ et’s, systemic lupus erythematosus and juvenile chronic arthritis. All patients continued their other medication including non-steroidal anti-inflammatory drugs and analgesics. Five continued low dose prednisolone (average 7.5 mg per day) all patients were monitored for safety and eAcacy throughout their treatment according to standard protocol. Five patients were enrolled in a study of eAcacy and safety where the dose of cyclosporin was reduced to 2.5 mg/kg/day at the time of conversion, i.e. to Neoral 2.5 mg/kg/day; 19 patients were converted dose for dose, cyclosporin A dose range 2.5‐4 mg/kg/day converted to Neoral dose range 2.5‐4 mg/kg/day and 27 patients started Neoral de novo. We conclude that cyclosporin is a useful disease modifying anti-rheumatic agent, and our experience suggests that the new formulation, Neoral, has a similar safety and eAcacy profile to the original preparation (Sandimmun). Neoral was relatively easy to manage and we noted a slight reduction in dose when compared to Sandimmun. With dose adjustments over 18 months the mean dose for patients with RA fell from 3.2 to 2.7 mg/kg/day and of the 27 patients starting Neoral de novo only seven required an increased dose above 2.5 mg/kg/day in order to establish eAcacy. OVER the last decade, rheumatologists have used second-line drugs more frequently to treat rheumatoid arthritis (RA), especially in patients with early disease. Cyclosporin obtained a product licence as a second-line drug 3 yr ago, leading to its increasing usage subsequently. Approximately 18 months ago, the makers of cyclosporin introduced a new preparation, ‘Neoral’, which may have caused some concern in those with only limited experience of cyclosporin ‘A’. We therefore describe our experience of the use of cyclosporin in its original preparation, Sandimmun, over the last 7 yr and using the new preparation, Neoral, in patients with rheumatic disease. We initially treated patients with severe RA who had failed conventional treatment, were unsuitable for second-line drugs, or who needed steroid-sparing agents. Later, we treated patients with early RA using cyclosporin as the first second-line drug and also treated a small number of patients with scleroderma, eosinophilic fasciitis, juvenile chronic arthritis, uveitis, psoriatic arthritis, enteropathic arthritis
Databáze: OpenAIRE
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