La ricerca bibliografica é stata effettuata sulla banca dati MEDLINE. Sono stati scelti i titoli dal 1981 ad oggi, prendendo in considerazione solo i lavori che riportassero trials terapeutici e non sperimentazione di laboratorio.
Title
Author
Fox DA; McCune WJ
Address
Division of Rheumatology, University of Michigan Medical Center, Ann Arbor.
Source
Rheum Dis Clin North Am, 1994 Feb, 20:1, 265-99
Abstract
This article reviews the biologic effects of cyclophosphamide and azathioprine relevant to the
treatment of systemic lupus erythematosus (SLE). Other agents used less commonly for SLE,
such as methotrexate, chlorambucil, and cyclosporin-A, receive more limited attention. Clinical
studies of efficacy and toxicity of these agents in their treatment of SLE are then described in
detail.
Language of Publication
English
Unique Identifier
94204303
Title
Author
Giunta G; Piazza I
Address
Department of Internal Medicine, Hospital of San Donà di Piave, Venice, Italy.
Source
Neth J Med, 1992 Apr, 40:3-4, 197-9
Abstract
Cyclosporin A is widely used in organ transplantation, preventing the rejection of multiple
types of organ allografts. It is also being increasingly used as an immunosuppressive agent
to treat various autoimmune diseases in patients refractory to more commonly used
immunosuppressive therapy. Several trials are currently evaluating the utility of this drug
associated with corticosteroids in the treatment of systemic lupus erythematosus. This case,
describing a lethal septicaemia caused by Listeria monocytogenes in a patient receiving this
treatment, seems to indicate that the use of these "cocktails" of immunosuppressive drugs
should be particularly cautious to prevent fatal infectious complications.
Language of Publication
English
Unique Identifier
92293353
Title
Author
Miescher PA; Favre H; Chatelanat F; Mihatsch MJ
Source
Klin Wochenschr, 1987 Aug 3, 65:15, 727-36
Abstract
Twenty-one patients suffering from different autoimmune diseases (14 from systemic lupus
erythematosus, 4 from rheumatoid arthritis, one from Sjögren's syndrome, one from
systemic hypersensitivity vasculitis, and one from diffuse proliferative glomerulonephritis)
were treated with a combined immuno-suppressive regimen. Cyclosporin was given at a
dose of 5 mg/kg/day together with steroids. In addition, the rheumatoid arthritis patients
also received methotrexate. In all patients a kidney biopsy was performed after a treatment
period of 17 to 42 months (mean duration 21.7 months). The cumulative cyclosporin dose
at the time of biopsy varied from 1.071 to 4.587 mg/kg. Patients suffering from systemic
lupus erythematosus and rheumatoid arthritis were assessed according to a scoring system
set up for this purpose. The combined therapy proved useful in these patients as reflected in
the diminution of the respective activity scores, improvement of kidney function, and
diminution of proteinuria. Histological examination of the kidney biopsy specimens showed
only minimal activity in patients with systemic lupus erythematosus. No unequivocal signs
of renal toxicity could be detected. In the last group, the condition of the patient with
Sjögren's syndrome was stabilized and the patient with systemic vasculitis improved
clinically. Neither patient had signs of kidney lesions. The patient with diffuse proliferative
glomerulonephritis, in whom kidney biopsy was performed before and after treatment,
showed improvement of kidney function, diminution of proteinuria, and diminution of
inflammatory activity within the kidney, and no signs of cyclosporin toxicity.
Language of Publication
English
Unique Identifier
87313152
Title
Author
Isenberg DA; Snaith ML; Morrow WJ; Al-Khader AA; Cohen SL; Fisher C; Mowbray J
Source
Int J Immunopharmacol, 1981, 3:2, 163-9
Abstract
Cyclosporin A (CyA) was given to five patients with active systemic lupus erythematosus
(SLE) at a dose of 10 mg/kg/day orally. No patient was able to take the drug for longer than
seven weeks because of side effects including nephrotoxicity. Angio-oedema was noted in
three patients and serum C1 esterase inhibitor levels were shown to be depressed in four out
of five patients whilst taking CyA. Two patients did experience an improvement in their
arthralgia but given the side effects induced we cannot, at present, recommend CyA for the
treatment of SLE.
Language of Publication
English
Unique Identifier
81263143
Title
Author
Tokuda M; Kurata N; Mizoguchi A; Inoh M; Seto K; Kinashi M; Takahara J
Address
First Department of Internal Medicine, Kagawa Medical School, Japan.
Source
Arthritis Rheum, 1994 Apr, 37:4, 551-8
Abstract
OBJECTIVE. To determine the effect of low-dose cyclosporin A (CSA) treatment on
disease activity in systemic lupus erythematosus (SLE). METHODS. All patients in the
study had active disease as defined by at least the presence of a low CH50 level. Patients
were initially given 3 mg/kg/day of CSA. Dosages were adjusted individually at every visit,
according to both clinical and laboratory data. RESULTS. Eleven women with SLE were
enrolled in the study; 10 were evaluable. After 20 weeks of CSA treatment, the mean score
for disease activity on the SLE Disease Activity Index decreased significantly, from 10.6 to
3.8 (P = 0.02). The titer of antinuclear antibodies decreased in 8 patients and the level of
anti-DNA antibodies decreased in 5. Side effects included hypertension (40%),
hypertrichosis (30%), gingival hypertrophy (10%), and a rise in the blood urea nitrogen
level. Serum creatinine levels remained unchanged. CONCLUSION. The favorable
responses observed in our patients strongly suggest that low-dose CSA can reduce the
disease activity of SLE.
Language of Publication
English
Unique Identifier
94197789
Title
Author
Caccavo D; Laganà B; Mitterhofer AP; Ferri GM; Afeltra A; Amoroso A; Bonomo L
Address
University La Sapienza, Rome, Italy.
Source
Arthritis Rheum, 1997 Jan, 40:1, 27-35
Abstract
OBJECTIVE: To evaluate the efficacy of long-term treatment with cyclosporin A (CSA) in
systemic lupus erythematosus (SLE). METHODS: Thirty patients with SLE whose
condition was either poorly responsive or unresponsive to treatment with steroids and/or
cytotoxic drugs were enrolled in a prospective, nonrandomized study of CSA. Patients with
hypertension or hypercreatinemia were excluded. Disease activity was evaluated according
to the systemic lupus activity measure. Assessments were made prior to study entry and
after 6, 12, 18, and 24 months. RESULTS: Twenty-seven patients completed at least 24
months of treatment with CSA. The mean disease activity score significantly decreased after
6 months of therapy (P < 0.01); this result was maintained throughout the study. A
conspicuous steroid-sparing effect was observed following administration of CSA (P <
0.01). Side effects included hypertrichosis (63% of patients), paresthesias (23%),
gastrointestinal symptoms (20%), gingival hyperplasia (17%), hypertension (10%), tremors
(7%), and nephrotoxicity (13%). No significant changes in serum creatinine levels were
observed. CONCLUSION: CSA represents a helpful second-choice treatment for patients
with active SLE. Administration of CSA necessitates expert and careful followup of
patients.
Language of Publication
English
Unique Identifier
97161340
Title
Author
Herrmann DB; Bicker U
Address
Boehringer Mannheim GmbH, Research and Development Division Therapeutics, FRG.
Source
Klin Wochenschr, 1990, 68 Suppl 21:, 15-25
Abstract
Autoimmune diseases arise when autoimmunity or the loss of self tolerance results in tissue
damages. Many mechanisms have been proposed for the origin of autoimmunity, including
immunologic, viral, hormonal and genetic factors. All known parts of the immunological
network are involved in causing immunopathologic symptoms. Therefore, more or less
specific immunosuppressants are widely used in the treatment of autoimmune disorders
which range from organ-specific, i.e. Hashimoto's thyroiditis, to non-organ-specific or
systemic diseases, i.e. systemic lupus erythematosus. Unspecifically acting cytostatics do
not only suppress autoimmune reactions but also create severe side-effects due to the
impairment of immune responses against foreign antigens, leading, for example, to an
increased risk of infections. Moreover, the genotoxic activity of cytostatics might induce
malignancies. Corticosteroids are clinically well known and very active agents for the
management of acute symptoms but different side-effects limit their use in the treatment of
chronic diseases. Cyclosporin A has been an important step forward to a more specific
prevention of organ transplant rejections and to the therapy of some autoimmune disorders.
Modern approaches to immunosuppression include monoclonal antibodies directed against a
variety of different determinants on immunocompetent cells. Ciamexone and Leflunomide
which are in early clinical and preclinical development, respectively, might be interesting
new drugs. Future immunopharmacologic drug research and development should lead to
more specific, low molecular weight, orally active and chemically defined
immunosuppressive compounds with good tolerability under long-term treatment of
autoimmune diseases.
Language of Publication
English
Unique Identifier
90331423
Title
Author
Russell AS; Bretscher PA
Source
J Rheumatol, 1987 Jun, 14 Suppl 13:, 194-8
Abstract
The therapeutic efficacy of immunosuppressive therapy in lupus and lupus nephritis in
particular, is reviewed. We have tried to resolve the paradox between the observed
immunostimulatory effects of cyclophosphamide and cyclosporin A in vivo and our concept
of an immunosuppressive agent.
Language of Publication
English
Unique Identifier
87283611
Title
Author
Manger K; Kalden JR; Manger B
Address
Department of Internal Medicine III, University Erlangen-Nuremberg, Germany.
Source
Br J Rheumatol, 1996 Jul, 35:7, 669-75
Abstract
In order to define the effects and safety of cyclosporin A (CsA) in systemic lupus
erythematosus (SLE), we conducted an open clinical trial with 16 SLE patients. During an
observation period of up to 64 months and an average treatment period of 30.3 months, 16
SLE patients, who did not have adequate disease control or experienced side-effects with
their previous immunosuppressive therapy, were treated with CsA (3-5 mg/kg). In 3/16
patients, CsA treatment was discontinued because of side-effects, in two because of
inefficacy and in 2/16 because of a pregnancy. Four out of 16 patients had a flare of disease
during CsA therapy 7, 24, 36 and 40 months after initial response to therapy; one patient
stopped CsA treatment after 54 months of successful disease control. Four out of 16
patients are still on CsA. The best beneficial effect was observed in 10 patients with
proteinuria, which decreased from 4.7 +/- 2.6 to 1.5 +/- 1.1 g/24 h. In 3/3 patients with
thrombocytopenia and 3/3 patients with leucocytopenia, platelets and leucocytes returned to
normal values. The most frequent side-effects were hypertension and deterioration of renal
function (3/16) and hypertrichosis (5/16). According to the preliminary results of this study,
CsA was well tolerated and able to control disease activity over an extended time period.
These data should encourage investigators to perform a multicentre controlled trial on CsA
therapy in SLE.
Language of Publication
English
Unique Identifier
96302491