Ciclosporin versus Azathioprine in Rheumatoid Arthritis

Summary

Ciclosporin (CyA) and azathioprine were compared with respect to efficacy, safety and tolerance in rheumatoid arthritis. Twelve patients were treated with ciclosporin 10 mg/kg/day and 12 patients with azathioprine 2.5–3 mg/kg/day for 26 weeks in an open, controlled and randomized study. All patients received prednisolone 5 mg/day as basic therapy. Both groups demonstrated an improvement in the majority of clinical parameters. There was a tendency towards more improvement in the ciclosporin group than in the azathioprine group. At the end of the study the patients on ciclosporin used a lower prednisolone dose than those on azathioprine. Reduction in the C-reactive protein (CRP) levels was seen in both groups, while the sedimentation rate was augmented in the ciclosporin group and reduced in the azathioprine group compared to baseline levels.

Four of the patients on azathioprine and 2 of the patients on ciclosporin had to discontinue the treatment due to side effects and one of the patients on azathioprine had to discontinue due to an unacceptable increase in disease activity.

An increase in serum creatinine and potassium as well as in systolic and diastolic blood pressure compared with baseline values was observed in the ciclosporin group but not in the azathioprine group. These parameters returned to normal after termination of treatment, except for an irreversible augmentation in serum creatinine in one patient who had signs of renal dysfunction prior to therapy.