The use of cyclosporin A microemulsion in rheumatoid arthritis: conclusions of an international review.

R arthritis (RA) is a painful and disabling condition that is increasingly widely recognized as being associated with early mortality. Since the late 1970s, clinical trials have been conducted in both Europe and North America to determine whether oral cyclosporin A (CyA) has a role in the management of RA, and, if so, how it might best be used. That experience, plus advances in our understanding of the mechanisms of action of CyA and the pathology of RA, provided the foundation for the recommendations of the 1992 International Consensus Report on the use of CyA in RA [1]. These recommendations were updated at a subsequent International Review in 1994 [2]. The advice presented below is derived from a further review of the recommendations, in which a trend towards early implementation of therapy, increased clinical experience with CyA, and the development of the new microemulsion formulation of CyA (Sandimmun Neoral) were taken into consideration. A secondary goal of the review was to provide clear and accessible guidance to physicians wishing to prescribe the CyA microemulsion to their patients with RA, within the context of specific national prescribing information. The assumption is made that CyA will be administered outside experimental research protocols by physicians experienced in the management of RA.