Stopping Cyclosporine Research Articles

Prolonged remission after cyclosporine therapy in pemphigus vulgaris: Report of two young siblings

We report the clinical evolution of two young siblings with severe pemphigus vulgaris treated with cyclosporine for 30 and 12 months, respectively. One was resistant to treatment with high-dose corticosteroids and azathioprine. A good clinical response was achieved in both cases. No major side effects were observed. The patients have remained disease free for more than 20 months after stopping cyclosporine therapy.

Cyclosporin: Poorly Tolerated in Familial Mediterranean Fever

Cyclosporin is poorly tolerated in patients with amyloidosis due to familial mediterranean fever who are receiving colchicine. There is a high incidence of gastrointestinal side-effects and muscle weakness, both of which are reversible on stopping cyclosporin. Thus in patients with amyloidosis secondary to familial mediterranean fever treated with colchicine, the use of cyclosporin as an immunosuppressive agent may be restricted.

Safe conversion from cyclosporine to azathioprine with improved renal function in pediatric renal transplantation.

Although cyclosporine has improved allograft survival in renal transplant patients, problems with drug toxicity remain, raising the question whether cyclosporine should be stopped at some point post-transplant. However, the relative safety of converting from cyclosporine to another immunosuppressive agent, or simply stopping cyclosporine remains an issue of debate and has not been evaluated in children. We have developed a protocol to convert children, who are 6 months post-transplant and have stable kidney function, from cyclosporine and prednisone to azathioprine and prednisone. Eleven children have undergone conversion because of suspected/potential nephrotoxicity or because of other difficulties with cyclosporine (expense, hirsutism). These children were compared with a control group of 12 children who met all criteria for conversion at 6 months but remained on cyclosporine. Allograft survival was similar in both groups but the children converted from cyclosporine experienced an improvement in renal function as measured by calculated creatinine clearance. There were no episodes of rejection for a period of 4 months post-conversion and all rejection episodes that developed subsequently occurred during or after the change from daily to alternate-day prednisone. We believe that conversion from cyclosporine to azathioprine can be accomplished safely in children with stable allograft function but long-term risks and benefits need further evaluation.

Open Trial of Cyclosporine in Patients with Severe Active Crohn's Disease Refractory to Conventional Therapy

Fifteen patients with severe active Crohn's disease, refractory to conventional therapy, were given a 16 week course of cyclosporine ar an initial oral daily dose of 10 mg/kg, adjusted to maintain cyclosporine scrum trough levels between 100 and 200 ng/ml. Five patients withdrew early because of side effects, poor absorption or noncompliance. T he remaining 10 patients all improved within four weeks as measured by three different clinical indices: Crohn's Disease Activity Index, Simple Index of Crohn's Disease Activity and Mean Score of Therapeutic Goals (MSTG). Seven patients maintained this initial improvement and prednisone was either reduced or discontinued. Four of these seven patients relapsed with in four weeks of stopping cyclosporine, and three remain in remission after 75 ± 2 weeks. Side effects were minor and easily reversible. When the various clinical and laboratory indices were compared, MSTG was found to be the most useful index for the assessment of therapy. Cyclosporine appears to be a safe and effective therapy in patients with severe active Crohn's disease refractory to conventional therapy.

Cyclosporin for Crohn's disease.

Eight patients with active uncomplicated Crohn's disease, who were resistant to or intolerant of conventional treatment, were treated for 6 weeks with oral cyclosporin (mean dose 8.2 mg kg-1 day-1). Seven of the eight patients responded to treatment with cyclosporin by symptomatic improvement, weight gain and a return of serum C-reactive protein concentration towards normal. All patients relapsed on stopping cyclosporin. No serious side-effects were encountered. This favourable early experience justifies further trials using cyclosporin for active Crohn's disease.

Pregnancy after autografting and allografting vascularized ovaries and en bloc vascularized ovaries with adnexa in rabbits

Initially, techniques for autografting ovaries with or without adnexa were developed but a 30% vascular failure rate was experienced by day 14. Of the technically successful grafts, 50% proved fertile. Single vascularized ovaries with their oviducts were then allografted into bilaterally ovariectomized rabbits by microsurgical techniques and the vascular failure rate was reduced to 5% of 40 grafts. The time-course of rejection in untreated recipients was mapped by histological examination and by 24-h culture of fallopian tubes after autopsy at different times after transplantation. Control allografts were consistently rejected by day 20. Striking prolongation of both types of graft was obtained with a short 17-day course of cyclosporin A at 10 or 15 mg day-1 kg-1. Indeed, significant evidence of rejection was found in only two ovaries out of 20 so far examined histologically. Mating behaviour, ovulation, ciliary function and transport of ova appeared normal in 80% of the recipients as long as 18 weeks after stopping cyclosporin A treatment. Only one of the ovarian allografted rabbits has so far been mated and this produced seven normal young 126 days after transplantation. However, none of the five animals mated after being allografted with en bloc adnexa have so far become pregnant.