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The Use of Cyclosporine A in Rheumatology: a 2016 Comprehensive Review

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Abstract

Cyclosporine A, an inhibitor of calcineurin, exerts an immunomodulator action interfering with T cell activation. Even though novel therapeutic tools have emerged, CyA still represents a suitable option in several clinical rheumatology settings. This is the case of refractory nephritis and cytopenias associated with systemic lupus erythematosus. Furthermore, CyA is a valued therapeutic tool in the management of uveitis and thrombophlebitis in course of Behçet’s disease. Topical CyA has been proven to be beneficial in the dry eye of Sjogren’s syndrome, whereas oral treatment with CyA can be considered for the severe complications of adult onset Still’s disease. CyA provides a therapeutic option in psoriatic arthritis, being rather effective in skin disease. CyA is currently regarded as a second-line option for patients with inflammatory myopathies refractory to standard regimen. CyA is used even in paediatric rheumatology, in particular in the management of juvenile dermatomyositis and macrophage activation syndrome associated with systemic juvenile idiopathic arthritis. Importantly, CyA has been shown to suppress the replication of HCV, and it can thus be safely prescribed to those patients with chronic hepatitis C. Noteworthy, CyA can be administered throughout the gestation course. Surely, caution should be paid to CyA safety profile, in particular to its nephrotoxicity. Even though most evidence comes from small and uncontrolled studies with few randomised controlled trials, CyA should be still regarded as a valid therapeutic tool in 2016 rheumatology.

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Acknowledgments

This work was supported in part by Ricerca Corrente IRCCS Istituto Auxologico Italiano to PLM.

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Authors and Affiliations

  1. Allergology, Clinical Immunology and Rheumatology Unit, IRCCS Istituto Auxologico Italiano, piazzale Brescia 20, 20149, Milan, Italy

    Cecilia Beatrice Chighizola

  2. Experimental laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095, Cusano Milanino, Milan, Italy

    Cecilia Beatrice Chighizola & Pier Luigi Meroni

  3. Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy

    Cecilia Beatrice Chighizola & Pier Luigi Meroni

  4. Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK

    Voon H. Ong

  5. Division of Rheumatology, ASST G. Pini, Pzza C Ferrari 1, 20122, Milan, Italy

    Pier Luigi Meroni

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  1. Cecilia Beatrice Chighizola
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  2. Voon H. Ong
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  3. Pier Luigi Meroni
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Correspondence to Pier Luigi Meroni.

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Chighizola, C.B., Ong, V.H. & Meroni, P.L. The Use of Cyclosporine A in Rheumatology: a 2016 Comprehensive Review. Clinic Rev Allerg Immunol 52, 401–423 (2017). https://doi.org/10.1007/s12016-016-8582-3

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