Cyclosporine, an oral medicine that suppresses the immune system, usually is prescribed to transplant patients to prevent organ rejection, and to patients with autoimmune diseases like rheumatoid arthritis (RA).
It also is used as a long-term treatment of the symptoms of severe myasthenia gravis, a rare chronic condition caused by the patients’ own immune cells attacking healthy tissues. Cyclosporine suppresses immune activity, so that “attacking” immune cells aren’t stimulated into action in the first place.
How cyclosporine works
The immune system normally protects the body from damaging invaders such as bacteria and viruses. In case of an infection, the immune system reacts by activating specialized cells (T-cells), which activate another type of immune cell (B-cells) to produce antibodies against invaders. Antibodies bind to and mark these organisms to be destroyed by other cells of the immune system. In myasthenia gravis, however, B-cells mistakenly produce antibodies against acetylcholine, a neurotransmitter connecting nerves and muscles. As a result, muscle-nerve connections are marked for destruction, causing muscular weakness.
Cyclosporine inhibits a molecule called interleukin 2, which normally activates T-cells. The end result is the inhibition of the immune reaction.
Cyclosporine in clinical trials
Cyclosporine was first identified by researchers at Sandoz as an anti-fungal compound in 1971. Further research revealed the strong ability of cyclosporine to suppress the immune system.
Starting in 1976, clinical trials focused on cyclosporine’s effectiveness in organ transplant patients. Based on results, the U.S. Food and Drug Administration (FDA) approved cyclosporine in 1983 for use in transplant patients.
A number of clinical studies also evaluated cyclosporine in myasthenia gravis patients whose symptoms kept worsening despite other treatments. Reports from 1987, 1993, 1997, and 2005 have shown that cyclosporine is safe to use and significantly improves muscle strength within two months in myasthenia gravis patients.
Common side effects of cyclosporine are allergic reactions, elevated blood pressure, acne, diarrhea, numbness, nausea, tremors, and increased body or facial hair growth.
Cyclosporine also can have more serious side effects that make it an undesirable medicine despite its rapid response rate. Some of these side effects include mood changes, kidney and liver problems, seizures, and dangerously high blood pressure.
Difficulty in urinating, swelling of the ankles or feet, and shortness of breath may indicate kidney problems. Liver problems can present as nausea, stomach pain, itching, yellowing of skin and whites of the eyes, dark urine, or clay-colored stool. A severe headache, blurred vision, pounding in neck or ears, nosebleed, confusion, chest pain, or irregular heartbeats. may be signs of high blood pressure. Patients should inform their doctors immediately if they recognize any of these side effects.
By suppressing the immune system, cyclosporine makes patients more vulnerable to infections and cancer. It is advisable to avoid close interaction with people who might have a contagious disease while using the medicine. It also is crucial to avoid direct sunlight or tanning beds to reduce the risk of developing skin cancer. Flu-like symptoms, or lumps anywhere in the body, should be reported immediately to the treating physician.
Cyclosporine interacts with many other medicines and should not be used in combination with them. These might be prescription medications like antibiotics, or over-the-counter supplements such as St. John’s Wort. That’s why it is critical to tell the doctor about all the drugs and supplements the patient uses.
Myasthenia Gravis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.