Tugwell P
Department of Medicine, University of Ottawa, Ontario, Canada.
Semin Arthritis Rheum. 1992 Jun;21(6 Suppl 3):30-8. doi: 10.1016/0049-0172(92)90011-2.
The experience from eight open studies and five controlled trials of cyclosporine in rheumatoid arthritis is reviewed. A therapeutic approach characterized by low initial doses and slow upward titration appears to minimize the toxicity while retaining sufficient amounts of the efficacy seen with higher doses, although the onset of benefit is slower. In short-term studies, renal dysfunction and other side effects appear to be reversible. However, studies of combinations of cyclosporine and other slow-acting agents, long-term studies, and more renal biopsy specimens are needed to determine the appropriate use of this agent. Cyclosporine holds promise as an important addition to the therapeutic armamentarium for patients with rheumatoid arthritis.
回顾了环孢素治疗类风湿性关节炎的八项开放性研究和五项对照试验的经验。一种以低初始剂量和缓慢递增滴定为特征的治疗方法似乎能在将毒性降至最低的同时，保持高剂量时所具有的足够疗效，尽管获益起效较慢。在短期研究中，肾功能障碍和其他副作用似乎是可逆的。然而，需要进行环孢素与其他慢作用药物联合使用的研究、长期研究以及更多的肾活检标本研究，以确定该药物的合理使用方法。环孢素有望成为类风湿性关节炎患者治疗药物库中的重要补充药物。
