Rheumatology, Vol 38, 254-259, Copyright © 1999 by British Society for Rheumatology
BE van den Borne, RB Landewe, HS Goei The, FC Breedveld and BA Dijkmans
OBJECTIVES: To investigate (1) whether the increase in serum creatinine
observed during cyclosporin A (CsA) therapy was reversible in a group of
patients with rheumatoid arthritis (RA) treated before the current
guidelines for safe use in RA were developed and (2) whether the
application of these guidelines prevents serum creatinine increases in the
long term. PATIENTS AND METHODS: Eighty-three RA patients who had started
low-dose CsA therapy between September 1990 and October 1992, and who were
treated according to guidelines that allowed a 50% rise in serum
creatinine, were tested for serum creatinine levels in December 1995 if
they had discontinued CsA for at least 3 months. Predictors for
irreversibility of renal function were determined by using multiple
regression analysis. RESULTS: The mean level of serum creatinine gradually
increased from 69+/-14 (mean+/-S.D.) micromol/l when starting CsA therapy
to 88+/-23 micromol/l (28% above baseline) at the moment of CsA
discontinuation, and had decreased to 80+/-17 micromol/l (16% above
baseline) at follow-up, 35+/-14 months after drug discontinuation. During
CsA therapy, the mean level of serum creatinine had increased to 82+/-19
micromol/l (26% above baseline) at 6 months and to 87+/-22 micromol/1 (39%
above baseline) at 42 months. The mean CsA dose had decreased from
3.1+/-0.9 mg/kg/day at 6 months to 1.9+/-0.8 mg/kg/day at 42 months. The
absolute number of months that serum creatinine levels were > 30% above
baseline was an independent predictor for a persistent increase of the
serum creatinine after CsA discontinuation. More than 2 months with a serum
creatinine increase of > or = 30% resulted in a higher percentage
irreversible increase than for less than 2 months with a > or = 30%
increase: 27 and 6%, respectively (P < 0.0001). CONCLUSION: Long-term
low-dose CsA administration in RA patients was associated with an increase
in serum creatinine which was partially irreversible after drug
discontinuation. The increase in serum creatinine was completely reversible
in the patient group that was treated according to the current guidelines
for safe use of CsA.
ORIGINAL PAPERS
Cyclosporin A therapy in rheumatoid arthritis: only strict application of the guidelines for safe use can prevent irreversible renal function loss
Department of Rheumatology, Leiden University Medical Centre, The Netherlands.
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