Barthélémy H, Thivolet J, Cambazard F, Bendelac A, Mauduit G, Granier F, Frappaz A
Ann Dermatol Venereol. 1986;113(4):309-13.
Bullous pemphigoid is a typical autoimmune disease. It is classically treated with systemic corticosteroids alone or combined with immunosuppressants. Cyclosporine A (CyA), a new immunosuppressive agent with high activity in organs and bone marrow transplantation, could be expected to prove effective in this disease owing to its action on lymphocytes. Seven patients with bullous pemphigoid were treated with CyA in daily doses of 6 to 8 mg/kg bodyweight. Treatment was monitored by measurements of serum CyA, creatinine and liver enzyme levels. The effectiveness of treatment was assessed on clinical changes. The seven cases are dealt with individually, with a brief case-report for each of them. The only side-effects observed were reversible rises in serum creatinine levels and hypertrichosis in two cases; these are usual reactions to the drug. Hormonal assays were normal in two female patients. Concerning results, our patients fell into two groups. Among those treated with CyA alone there were two failures and two sustained satisfactory results. Treatment was successful in all patients treated with CyA during relapses under corticosteroid therapy, but two patients relapsed after CyA was discontinued. It is concluded that CyA is of no interest in the acute phase of bullous pemphigoid, that the long-term stability of the results obtained is doubtful and that this potentially nephrotoxic drug should be avoided or administered with extreme caution in elderly people, since their renal function may be at the limit of normality.
大疱性类天疱疮是一种典型的自身免疫性疾病。传统上，其治疗方法是单独使用全身性皮质类固醇或与免疫抑制剂联合使用。环孢素A（CyA）是一种在器官和骨髓移植中具有高活性的新型免疫抑制剂，由于其对淋巴细胞的作用，有望在这种疾病中证明有效。7例大疱性类天疱疮患者接受了CyA治疗，日剂量为6至8mg/kg体重。通过测量血清CyA、肌酐和肝酶水平来监测治疗情况。根据临床变化评估治疗效果。对这7例病例分别进行处理，每个病例都有简短的病例报告。观察到的唯一副作用是血清肌酐水平可逆性升高以及2例出现多毛症；这些是该药物的常见反应。2例女性患者的激素检测结果正常。关于治疗结果，我们的患者分为两组。在仅接受CyA治疗的患者中，有2例治疗失败，2例持续取得满意效果。在皮质类固醇治疗复发期间接受CyA治疗的所有患者治疗均成功，但2例患者在停用CyA后复发。得出的结论是，CyA在大疱性类天疱疮急性期无应用价值，所获结果的长期稳定性值得怀疑，并且这种具有潜在肾毒性的药物在老年人中应避免使用或极其谨慎地使用，因为他们的肾功能可能已接近正常极限。
