Treatment of severe and diYcult cases of systemic lupus erythematosus with tacrolimus. A report of three cases

Objectives—An analysis of the eYcacy of tacrolimus treatment in three patients with diYcult and severe systemic lupus erythematosus (SLE) whose active disease had been previously poorly controlled by cyclosporine and cyclophosphamide. Methods—A review of patient notes. Results—Two patients are well controlled after six and nine months of treatment with tacrolimus 0.06 mg/kg/day and 0.18 mg/kg/day. Previous persistent vasculitis had resolved and other features of active disease were controlled. The third patient’s vasculitis had not improved significantly after two months of treatment and tacrolimus 0.17 mg/kg/day was discontinued because of nephrotoxicity. Conclusion—Tacrolimus may be a useful additional immunosuppressive agent in some patients whose SLE is not well controlled by conventional treatments. (Ann Rheum Dis 1997;56:690–692) Several groups have reported the eYcacy of cyclosporine in systemic lupus erythematosus (SLE). There have been no previous reports of the treatment of the connective tissue diseases with the other immunophilin ligands, such as tacrolimus or rapamycin, although tacrolimus (FK506) has been successfully used in the treatment of other autoimmune diseases. 5 We report the treatment of three cases of severe and diYcult SLE with tacrolimus.