Cyclosporine

Article Abstract:

Cyclosporine is a drug that suppresses the immune system, preventing it from mounting a response against foreign substances. The use of cyclosporine has dramatically improved the survival of patients who have received transplantation of various organs, including kidney, liver, heart, and lung. Cyclosporine is also effective in the treatment of autoimmune diseases, in which the immune system recognizes its own tissues as foreign. However, proper treatment with this drug is complicated, as it can have a variety of toxic side effects. Neurological side effects include tremor, headaches, confusions, depression, seizures and coma. There are complication of the skin, the gastrointestinal tract such as nausea and vomiting, and the endocrine system such as high blood sugar. The drug can cause liver damage, increased bone formation and complications with blood vessels and the blood. The dosage is difficult to determine because of wide individual differences in the absorption of the drug, its distribution in tissues or the blood, and the time needed to eliminate the drug from the system. At the same time, the methods available for detecting the level of cyclosporine in the patient are not accurate. Therefore, it is difficult to maximize the therapeutic effects of the drug while minimizing the toxic effects. Currently, the amount of cyclosporine used for therapy is near the level of toxicity. Future studies hope to improve the use of cyclosporine, either by combining it with other drugs and immunosuppressive agents or by developing shorter treatment periods.

Research, Physiological aspects, Immunosuppressive agents, Transplantation immunology, Drug metabolism, column

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Systemic treatment of severe psoriasis: the role of cyclosporine

Article Abstract:

Psoriasis, a chronic skin disorder involving plaques and scales, can cover large areas of the body. The involved skin acquires characteristic histological changes and becomes inflamed. Topical treatments include corticosteroids or anthralin, and ultraviolet light can be beneficial. An agent used in systemic treatment is cyclosporine (an immunosuppressant), a report on which appears in the January 31, 1991 issue of The New England Journal of Medicine. The study established an optimal dose for treating psoriasis. Whether long-term therapy with this drug is wise can be questioned, since transplant patients who take it have an elevated incidence of skin cancer. Suppression of the immune system over long periods of time is associated with malignancy. Other treatments for severe psoriasis can be considered. These include methoxsalen, long-wave ultraviolet A irradiation (PUVA phototherapy), and etretinate. The side effects of these methods are discussed. A derivative of etretinate, acitretin, also appears effective. Side effects include toxicity to the liver and oral ulcers (with methotrexate) and fetal damage (with etretinate). In general, systemic treatments should be alternated to avoid the toxicity associated with any one approach. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Psoriasis, editorial, Etretinate

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Risk factors for cyclosporine-induced nephropathy in patients with autoimmune diseases

Article Abstract:

The risk of developing kidney disease among patients with autoimmune diseases who are treated with cyclosporine may be reduced by decreasing the dosage and monitoring their blood creatinine levels. Cyclosporine is an immunosuppressant that is commonly used to treat patients with autoimmune disease. Of 192 patients with autoimmune disease, 41 developed kidney disease induced by treatment with cyclosporine. Patients who developed kidney disease were initially treated with an average of 9.3 milligrams (mg) of cyclosporine per kilogram per day, compared with an average of 8.0 mg per kilogram per day among those who did not develop kidney disease. The blood creatine level of patients who developed kidney disease was an average of 101% above normal, compared to 50% among those who did not develop kidney disease. The average age of those who developed kidney disease was 31 years, compared with 23 years among those who did not develop kidney disease.

Risk factors, Drug therapy, Autoimmune diseases, Kidney diseases

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