Dijkmans B A, van Rijthoven A W, Goei Thè H S, Boers M, Cats A
Department of Rheumatology, Leiden University Hospital, The Netherlands.
Semin Arthritis Rheum. 1992 Aug;22(1):30-6. doi: 10.1016/0049-0172(92)90046-g.
The efficacy and toxicity of cyclosporine in the treatment of patients with rheumatoid arthritis (RA) are reviewed. Most of the early trials were restricted to patients with intractable RA. The initial daily dose of cyclosporine was 5 to 10 mg/kg, which is now considered high. Of 283 cyclosporine-treated patients in nine studies, 8% discontinued the drug prematurely because of inefficacy and 17% because of adverse reactions. Cyclosporine improves clinical parameters but does not influence the erythrocyte sedimentation rate. The most important side effects are gastrointestinal intolerance and nephrotoxicity. The former is of minor importance with the present dosage schedule (starting daily dose, 2.5 mg/kg), and increments should follow the principle "go low, go slow." Guidelines are given to avoid or reduce nephrotoxicity. It may be beneficial to administer cyclosporine early in the course of RA.
本文综述了环孢素治疗类风湿关节炎（RA）患者的疗效和毒性。大多数早期试验仅限于难治性RA患者。环孢素的初始日剂量为5至10mg/kg，目前认为该剂量较高。在9项研究中接受环孢素治疗的283例患者中，8%因无效而提前停药，17%因不良反应停药。环孢素可改善临床指标，但不影响红细胞沉降率。最重要的副作用是胃肠道不耐受和肾毒性。按照目前的给药方案（起始日剂量2.5mg/kg），前者不太重要，剂量增加应遵循“低剂量、慢增量”原则。文中给出了避免或降低肾毒性的指南。在RA病程早期使用环孢素可能有益。
