News - Cyclosporin Compared To Gold For Treatment Of Rheumatoid Arthritis

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Cyclosporin Compared To Gold For Treatment Of Rheumatoid Arthritis

06/17/2002

By Anne MacLennan

Three-year changes in radiographic damage are similar for cyclosporin and

parenteral gold in treatment of early, active severe rheumatoid arthritis.

However, abnormal renal function and raised blood pressure were often seen

in the cyclosporin-treated patients in this multicentre European study

comparing long-term safety and efficacy of these two treatments.

T K Kvien and colleagues from the Oslo City Department of Rheumatology,

Diakonhjemmet Hospital, Oslo, Norway, with others from Germany, Finland,

Sweden and Switzerland, conducted this three-year study of radiographic

progression, renal function, and arterial hypertension in these patients.

The researchers also examined the reversibility of cyclosporin-linked renal

dysfunction in patients who discontinued treatment with this drug.

In an 18-month open extension to an 18-month randomised, parallel group

study, study participants continued to receive cyclosporin or parenteral

gold.

During follow-up, radiographic progression was found to be similar in both

groups. About 60 percent of patients in the intention to treat groups (272

people) and about half of those in the completer groups (114 people) showed

definite radiographic progression in joint damage, and about one in three

also had substantial progression.

Both systolic and diastolic blood pressure were significantly raised in the

cyclosporin versus the gold group, and 12 of 139 (nine percent) versus three

of 139 (two percent) had notably raised blood pressure.

At treatment end point, mean serum creatinine increased by 28 percent in the

cyclosporin group versus seven percent in the gold group. Mean calculated

creatinine clearance was reduced by 16 percent in the cyclosporin group and

increased by one percent in the gold group at the end of the study.

At final follow up after cyclosporin was discontinued (at least three months

after treatment was stopped), mean serum creatinine was increased by 15

percent and creatinine clearance reduced by 16 percent.

Sustained increases in serum creatinine at this post-treatment end point

were mostly seen in patients with a raised serum creatinine during treatment

of at least 50 percent.

ls of the Rheumatic Diseases 2002;61:511-516