Rheumatology International

, Volume 25, Issue 1, pp 15–22

An open, randomized comparison study of cyclosporine A, cyclosporine A + methotrexate and cyclosporine A + hydroxychloroquine in the treatment of early severe rheumatoid arthritis

  • Piercarlo Sarzi-Puttini
  • Enzo D’Ingianna
  • Mario Fumagalli
  • Magda Scarpellini
  • Tania Fiorini
  • Enrico Luigi Chérié-Lignière
  • Benedetta Panni
  • Franco Fiorentini
  • Vincenzo Corbelli
  • Nebiat Belai Beyene
  • Claudio Mastaglio
  • Carlo Severi
  • Maurizio Locati
  • Marco Cazzola
  • Guido Menozzi
  • Giuseppe Monti
  • Francesco Saccardo
  • Giuseppina Alfieri
  • Fabiola Atzeni
Original Article

Abstract

Purpose

To determine whether a regimen of cyclosporine (CSA) and methotrexate (MTX), or CSA and hydroxychloroquine (HCQ) introduced in early rheumatoid arthritis (RA) can produce a significant improvement in clinical outcome and/or retard radiographic damage in comparison with standard monotherapy with CSA alone.

Methods

One hundred five patients with active RA of less than 36 months duration, who had never previously been treated with immunosuppressive agents, were included in a 12-month, multi-center, open, randomized trial. Patients who fulfilled the criteria for early severe RA were randomized to receive either combination therapy (CSA+MTX n=34, CSA+HCQ n=35) or CSA alone (n=36).

Results

CSA+MTX was more effective than the other two treatment groups in controlling RA symptoms. CSA+MTX did not show a significant radiographic progression according to Larsen–Dale (0.90±3.89 compared to baseline values, P>0.05); moreover, patients treated with CSA alone or CSA+HCQ showed a significant worsening of Larsen–Dale score (2.91±5.99 and 2.97±4.28 respectively vs baseline values, P<0.05), although not significant when compared with the CSA+HCQ group (P=0.56 and 0.39, respectively).

Conclusions

This trial indicated that CSA+MTX was more effective than the other two treatments in improving clinical data and inhibiting radiographic progression, although the differences were not significant in this relatively small study. However, the difference was significant in favor of CSA+MTX regarding ACR 50% response.

Keywords

Rheumatoid arthritis Cyclosporine A Methotrexate Hydroxychloroquine 

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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Piercarlo Sarzi-Puttini
    • 1
  • Enzo D’Ingianna
    • 2
  • Mario Fumagalli
    • 3
  • Magda Scarpellini
    • 4
  • Tania Fiorini
    • 1
  • Enrico Luigi Chérié-Lignière
    • 5
  • Benedetta Panni
    • 1
  • Franco Fiorentini
    • 2
  • Vincenzo Corbelli
    • 2
  • Nebiat Belai Beyene
    • 5
  • Claudio Mastaglio
    • 6
  • Carlo Severi
    • 6
  • Maurizio Locati
    • 7
  • Marco Cazzola
    • 7
  • Guido Menozzi
    • 8
  • Giuseppe Monti
    • 9
  • Francesco Saccardo
    • 9
  • Giuseppina Alfieri
    • 2
  • Fabiola Atzeni
    • 1
  1. 1.Unità Operativa di ReumatologiaUniversity Hospital L. SaccoMilanItaly
  2. 2.Unità Operativa di Reumatologia-Medicina InternaAzienda Ospedaliera Sant’AnnaComoItaly
  3. 3.Divisione di Medicina RiabilitativaIstituti clinici di PerfezionamentoMilanItaly
  4. 4.Unità Operativa di Reumatologia-Medicina InternaOspedale Busto ArsizioBusto ArsizioItaly
  5. 5.Unità Operativa di Medicina InternaOspedale BassiniCinisello BalsamoItaly
  6. 6.Unità Operativa di Riabilitazione e ReumatologiaOspedale di GravedonaGravedonaItaly
  7. 7.Unità Operativa di RiabilitazioneOspedale di SaronnoSaronnoItaly
  8. 8.Unità Operativa di Medicina InternaOspedale di SondrioSondrioItaly
  9. 9.Unità Operativa di Medicina Interna e ReumatologiaOspedale di SaronnoSaronnoItaly

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