Cyclosporine for treating rheumatoid arthritis

This review included three trials with a total of 318 patients. A statistically significant decrease in the number of tender and swollen joints was found for patients taking cyclosporine when compared to those taking placebo. Significant improvements in pain and function were also found for those patients taking cyclosporine. More side effects occurred in the cyclosporine group compared to the placebo group.

Cyclosporine has an important clinical benefit in the short-term (up to one year) treatment of patients with progressive rheumatoid arthritis.

Authors' conclusions: 

Cyclosporine has an important clinical benefit in the short-term (up to one year) treatment of patients with progressive rheumatoid arthritis.

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Background: 

Rheumatoid arthritis (RA) is an autoimmune disease characterized by an activation of T lymphocyte and an increase in interleukine turnover. In RA, cyclosporine is known to be efficient as a Disease Modifying Anti-Rheumatic Agent (DMARD), especially when other treatments such as injectable gold, D-penicillamine or anti-malarials were not efficacious.

Objectives: 

To estimate the short-term (up to one year) effects of cyclosporine for rheumatoid arthritis.

Search strategy: 

We searched the Cochrane Musculoskeletal Group trials register, and MEDLINE, up to 1997, using the search strategy developed by the Cochrane Collaboration (Dickersin 1994). The search was complemented with bibliography searching of the reference list of the trials retrieved from the electronic search. Key experts in the area were contacted for further published and unpublished articles.

Selection criteria: 

All randomized clinical trials (RCTs) and controlled clinical trials (CCTs) comparing cyclosporine against placebo in patients with rheumatoid arthritis.

Data collection and analysis: 

Two reviewers determined the trials to be included based on inclusion and exclusion criteria (GW, MSA). Data were independently abstracted by two reviewers (DH, GW),and checked by a third reviewer (BS) using a pre-developed form for the rheumatoid arthritis sub-group of the Cochrane Musculoskeletal Group.

Methodological quality of the RCTs and CCTs was assessed by two reviewers (BS, DH). Rheumatoid arthritis outcome measures were extracted from the publications for change from baseline endpoints. Sufficient data were obtained to include in the pooled analysis the number of swollen joints, physician global assessment, patient global assessment and erythrocyte sedimentation rate (ESR).

Main results: 

Three trials and 318 patients were included. A statistically significant decrease in the number of tender and swollen joints was observed for cyclosporine when compared to placebo. The standardized mean difference (SMD) for the change in the number of swollen joints was -0.969. Significant improvements in pain and the functional index were also found for cyclosporine. More side effects occurred in the cyclosporine group compared to placebo.

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