Clinical use of immunosuppressants in autoimmune diseases

Summary

The low-molecular-weight immunoregulants of which cyclosporine is the prototype offer several theoretic advantages in the therapy of autoimmune disease. Rheumatoid arthritis is the best studied example. Here, cyclosporine effects against CD4⁺ helper/inducer activation and the key cytokines, interleukin-2 and interleukin-8, would constitute an appropriate rationale for its use. Studies to date have suggested efficacy, but have been significantly hampered by adverse effects, most notably nephrotoxicity. Although the selection of refractory patients with long-standing disease for treatment has doubtlessly influenced these results, development of newer agents in this class will require the addressing of a presumed mechanism-based toxicity.