Tolerance of cyclosporine A in children with refractory juvenile rheumatoid arthritis

In an open trial, tolerance and safety of cyclosporine A was studied in 14 patients with refractory juvenile rheumatoid arthritis (JRA). The doses varied from 4-15 mg/kg/day. Treatment lasted for greater than 12 months in 11 and 6 to 9 months in 3 patients. Eleven patients were withdrawn due to lack of efficacy (4) or side effects (7). A drop of greater than 2 g/l in hemoglobin and a marked rise in serum creatinine were the cause of withdrawal in 5 patients. The effect of cyclosporine on disease activity seemed to be mainly symptomatic and temporary. Probably, the dose should be kept below 5 mg/kg/day. Future controlled studies should be aware of a risk of aggravation of anemia in children treated with cyclosporine.