The British Journal of Rheumatology, Vol 36, 1113-1115, Copyright © 1997 by British Society for Rheumatology
MF Somerville and DG Scott
Cyclosporin A is now well established as an effective 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 Behcet'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 efficacy throughout their
treatment according to standard protocol. Five patients were enrolled in a
study of efficacy 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 efficacy 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
efficacy.
ORIGINAL PAPERS
Neoral--new cyclosporin for old?
Rheumatology Department, Norfolk & Norwich Health Care NHS Trust, Norwich.
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