Kurki P T
Dept of Clinical Research, Sandoz Pharma Ltd, Basle, Switzerland.
Scand J Rheumatol Suppl. 1992;95:35-8. doi: 10.3109/03009749209101481.
The long term safety issues of cyclosporin A therapy of rheumatoid arthritis can be classified into two categories: side effects typical for the cyclosporin group of drugs and side effects due to the immunosuppression. A decrease in the renal function and elevation of the blood pressure are the main cyclosporin-related side effects. Blood pressure can be controlled in most cases by dose reduction or by antihypertensive therapy. With the current low dose strategy, a mild decrease of renal function is common but the incidence of permanent renal damage is low and the prognosis is good. Immunosuppression as such may predispose for malignancies and infections. Cyclosporin A is not mutagenic. However, it may impair the immunosurveillance for transformed cells. Data from organ transplantation suggest that immunosuppressive regimens including cyclosporin A increase the incidence of lymphoproliferative disorders and skin cancers. It is not clear whether cyclosporin A can increase the incidence of these tumors in patients with rheumatoid arthritis due to a relatively small number of patients studied thus far. Monitoring of cyclosporin A therapy of rheumatoid arthritis is simple but mandatory.
环孢素A治疗类风湿关节炎的长期安全性问题可分为两类：环孢素类药物典型的副作用以及免疫抑制导致的副作用。肾功能下降和血压升高是与环孢素相关的主要副作用。在大多数情况下，血压可通过减少剂量或抗高血压治疗得到控制。采用当前的低剂量策略，肾功能轻度下降较为常见，但永久性肾损害的发生率较低且预后良好。免疫抑制本身可能易引发恶性肿瘤和感染。环孢素A无致突变性。然而，它可能会损害对转化细胞的免疫监视。器官移植的数据表明，包括环孢素A在内的免疫抑制方案会增加淋巴增生性疾病和皮肤癌的发生率。由于迄今为止研究的患者数量相对较少，尚不清楚环孢素A是否会增加类风湿关节炎患者这些肿瘤的发生率。类风湿关节炎环孢素A治疗的监测简单但必不可少。
