[Clinical experiences with cyclosporin A in patients with systemic lupus erythematosus].

Introduction: Cyclosporin A is a peptide composed of 11 amino acids. Its immune suppressive effect is attributed to the suppression of proliferation of T lymphocytes. Recently, besides immune suppression after organ transplantation it is used in the treatment of autoimmune disorders, such as systemic lupus erythematosus.
Aims: In the present work authors examined the frequency, effectiveness and safety of cyclosporin A in patients with systemic lupus erythematosus, regularly followed at the above mentioned department.
Results: Of the 450 lupus patients one male and 21 females received cyclosporin A for 12.4 months (3-96). Before cyclosporin A administration 16 patients received combined immune suppressive therapy; 68.2% azathioprine, 27.3% chloroquine, 18.2% methotrexate, while 3 patients were treated with steroid alone. High autoantibody titres clinical activity and the need for reduction of steroid dose were the mean indications. Furthermore, cyclosporin A was started because of leukopenia in 45.5%, polyarthritis in 36.4% or both in 27.3% of patients. Four patients started cyclosporin A to control skin eruptions. Thrombocytopenia, autoimmune hemolysis, Evans' syndrome and pancytopenia indicated this therapy in one patient for each. Clinical effectiveness was indicated by the reduction of mean daily methylprednisolone dose from 25.1 mg to 8.36 mg and also by the reduction of the disease activity index (SLE-DAI) from 9.47 to 2.47 within the first half year of the treatment. Therapy was well-tolerated. Only 3 patients observed hypertrichosis. Cyclosporin A was stopped in 3 cases due to infection and in 1 patient due to bad compliance.
Conclusion: Present results suggest that cyclosporin A is an effective and safe treatment also in a certain group of lupus patients, especially with joint, skin and hematologic complications. Further long-term follow-up is required to evaluate late side-effects.