Skip to main content
SpringerLink
Log in

Cyclosporine in Resistant Systemic Arthritis - A Cheaper Alternative to Biologics

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objectives

To assess the efficacy of cyclosporine (CsA) in patients of oral steroid unresponsive or steroid dependent systemic juvenile idiopathic arthritis (sJIA); to evaluate the optimum dosage and blood level of CsA to achieve and maintain remission and to observe for side-effects on prolonged usage.

Methods

This prospective observational study was conducted on children with steroid dependent /refractory sJIA admitted at the Institute of Child Health, Kolkata from July 2009 through November 2014. A total of 82 sJIA was diagnosed; 15 were steroid dependent /refractory and were included as candidates for cyclosporine therapy.

Results

CsA was used in 15 patients; 13 showed a favourable response with significant steroid sparing effect and minimal toxicity.

Conclusion

CsA was found to be effective in almost 75% of frequently relapsing steroid dependent sJIA to achieve and maintain remission. The average cost of therapy for a 20 kg patient on CsA was found to be 10,000 INR (132 EURO)/ patient over a 6 mo period; which would amount to 100,000 INR (1318 EURO)/patient with Tocilizumab for the same duration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Beukelmen T, Patkar NM, Saag KG, et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res. 2011;63:465–82.

    Article  Google Scholar 

  2. Pay S, Turkcapar N, Kalyoncu M, et al. A multicenter study of patients with adult-onset Still’s disease compared with systemic juvenile idiopathic arthritis. Clin Rheumatol. 2006;25:639–44.

    Article  PubMed  Google Scholar 

  3. Gattorno M, Piccini A, Lasiglie D, et al. The pattern of response to anti–interleukin-1 treatment distinguishes two subsets of patients with systemic-onset juvenile idiopathic arthritis. Arthritis Rheum. 2008;58:1505–15.

    Article  CAS  PubMed  Google Scholar 

  4. Verbsky JW, White AJ. Effective use of the recombinant interleukin 1 receptor antagonist anakinra in therapy resistant resistant systemic onset juvenile rheumatoid arthritis. J Rheumatol. 2004;31:2071–5.

    PubMed  Google Scholar 

  5. De Benedetti F, Brunner HI, Ruperto N, et al; PRINTO; PRCSG. Randomized trial of tocilizumab in systemic juvenile idiopathic arthritis. N Engl J Med. 2012;367:2385–95.

  6. Ruperto N, Ravelli A, Castell E, et al. Cyclosporine A in juvenile idiopathic arthritis: results of the PRCSG/PRINTO phase IV post marketing surveillance study. Clin Exp Rheumatol. 2006;24:599–605.

    CAS  PubMed  Google Scholar 

  7. Gerloni V, Cimaz R, Gattinara M, Arnoldi C, Pontikaki I, Fantini F. Efficacy and safety profile of cyclosporin A in the treatment of juvenile chronic (idiopathic) arthritis: results of a 10-year prospective study. Rheumatology (Oxford). 2001;40:907–13.

    Article  CAS  Google Scholar 

  8. Ostensen M, Hoyerall HM, Kass E. Tolerance of cyclosporine A in children with refractory juvenile rheumatoid arthritis. J Rheumatol. 1988;15:1536–8.

    CAS  PubMed  Google Scholar 

  9. Wells G, Haguernauer D, Shea B, Suarez-Almazor ME, Welch VA, Tugwell P. Cyclosporine for rheumatoid arthritis. Cochrane Database Syst Rev. 2000;2:CD001083.

    Google Scholar 

  10. Gremese E, Ferraccioli GF. Benefit/risk of cyclosporine in rheumatoid arthritis. Clin Exp Rheumatol. 2004;22:S101–7.

    CAS  PubMed  Google Scholar 

  11. Ostensen M, Hoyeraal HM, Kass E. Tolerance of cyclosporine A in children with refractory juvenile rheumatoid arthritis. J Rheumatol. 1988;15:1536–8.

    CAS  PubMed  Google Scholar 

  12. Pistoia V, Buoncompagni A, Scribanis R, et al. Cyclosporin A in the treatment of juvenile chronic arthritis and childhood polymyositis-dermatomyositis. Results of a preliminary study. Clin Exp Rheumatol. 1993;11:203–8.

    CAS  PubMed  Google Scholar 

  13. Ravelli A, Moretti C, Tomporini F, et al. Combination therapy with methotrexate and cyclosporine A in juvenile idiopathic arthritis. Clin Exp Rheumatol. 2002;20:69–72.

    Google Scholar 

  14. Tugwell P, Pincus T, Yocum D, et al. Combination therapy with cyclosporine and methotrexate in severe rheumatoid arthritis. The Methotrexate-Cyclosporine Combination Study Group. N Engl J Med. 1995;333:137–41.

  15. Reiff A, Rawlings DJ, Shaham B, et al. Preliminary evidence for cyclosporin A as an alternative in the treatment of recalcitrant juvenile rheumatoid arthritis and juvenile dermatomyositis. J Rheumatol. 1997;24:2436–43.

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Pediatric Rheumatology Unit, Institute of Child Health, 11, Dr Biresh Guha Street, Kolkata, West Bengal, 700017, India

    Priyankar Pal

  2. Department of Pediatrics, Institute of Child Health, Kolkata, West Bengal, India

    Prabhas Prasun Giri

  3. Pediatric Nephrology Unit, Department of Pediatrics, Institute of Child Health, Kolkata, West Bengal, India

    Rajiv Sinha

Authors
  1. Priyankar Pal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Prabhas Prasun Giri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rajiv Sinha
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PP conceptualised the project. Both PP and PPG were involved in patient management and data collection. All three authors drafted the manuscript. Prof. Apurba Ghosh, Director, Institute of Child Health, Kolkata will act as guarantor for this paper.

Corresponding author

Correspondence to Priyankar Pal.

Ethics declarations

Conflict of Interest

None

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pal, P., Giri, P.P. & Sinha, R. Cyclosporine in Resistant Systemic Arthritis - A Cheaper Alternative to Biologics. Indian J Pediatr 86, 590–594 (2019). https://doi.org/10.1007/s12098-019-02912-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-019-02912-9

Keywords

Search

Navigation