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This review included three trials with a total of 318 patients. A statistically significant decrease in the number of tender and swollen joints was found for patients taking cyclosporine when compared to those taking placebo. Significant improvements in pain and function were also found for those patients taking cyclosporine. More side effects occurred in the cyclosporine group compared to the placebo group.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 27, 1998

Cyclosporine is an immunosuppressive agent discovered in 1972. It was first used to prevent rejection after organ transplantation and more recently, for management of autoimmune diseases. Common side effects associated with cyclosporine therapy are nephrotoxicity and hypertension. To observe the magnitude of elevated blood pressure caused by cyclosporine compared to placebo, we searched the available scientific literature. We identified 17 trials that met our inclusion criteria and had extractable data.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 20, 2010

The results of this review demonstrate that low dose oral cyclosporine is not effective for treatment of active Crohn's disease. Studies indicate that Crohn's patients treated with low dose (5 mg/kg/day) oral cyclosporine could experience side effects including kidney problems. Therefore the use of this medication for the treatment of chronic active Crohn's disease is not advisable. Higher oral doses and injections of cyclosporine have not been sufficiently evaluated. Larger doses of cyclosporine are not likely to be useful for the long‐term management of Crohn's disease due to the risk of kidney damage and the availability of other proven medications.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 20, 2005

Ulcerative colitis (UC) is a chronic inflammation of the large bowel. Symptoms include bloody diarrhea and abdominal pain. The disease can also have manifestations outside the bowel with involvement of the joints, skin, eyes and liver. While the 'first line' treatment for a severe attack of UC is usually steroids (either as pills or intravenously) the options for patients not responding to steroids are limited and include surgical removal of the large bowel. Cyclosporine A (CsA), a drug effective in preventing transplant organ rejection by suppressing the immune system, was tried in severe UC with encouraging results in the early 1990's. The aim of this review was to assess the effectiveness of CsA for severe UC. The literature search identified 36 studies. Only 2 studies were of high methodological quality and both support the use of CsA in UC patients with a severe attack. However, both studies were small (involving only 50 patients altogether) and limited in the length of follow‐up (from a few weeks up to a year). There is limited evidence that cyclosporine is more effective than standard treatment for severe ulcerative colitis. The conclusion of the review is that while the data concerning the use of CsA in severe UC are encouraging, more studies are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 24, 2005

Atopic keratoconjunctivitis (AKC) is an inflammatory disorder of the ocular surface that can be suffered by 67.5% of atopic dermatitis patients. It is a chronic condition that often requires long‐term treatment in order to avoid ocular complications that may lead to visual loss. This condition is frequently treated with steroid eyedrops, but long‐term treatment with such drugs can produce severe side effects, such as the development of cataracts, glaucoma or severe infections of the eye. Topical treatment with cyclosporine A (CsA) eyedrops may be useful to control signs and symptoms of atopic keratoconjunctivitis, and to reduce the need for steroid eyedrops.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: September 12, 2012

Oral lichen planus (OLP) is a condition where there are long‐term, painful areas on the lining of the mouth. The treatment is for reducing pain but there is no cure for this disease. Usual treatment is steroid ointment applied directly to the painful areas. This review found no research evidence to show that one type of steroid is better or worse than another. There is no evidence that a group of treatments called calcineurin inhibitors (e.g. pimecrolimus) are more effective than placebo. This review found that aloe vera may reduce pain and clinical signs of OLP.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 6, 2011

Almost every liver transplant recipient is treated with either the drug tacrolimus or the drug cyclosporine to prevent rejection of the transplanted liver. These drugs are part of a group of drugs called calcineurin inhibitors. Both tacrolimus and cyclosporine have serious and common adverse effects and, therefore, dose reduction or discontinuation of these drugs is frequently applied in clinical practice. The aim of the review was to compare reduction or withdrawal of tacrolimus or cyclosporine without substitution with another immunosuppressive agent with continuation of tacrolimus or cyclosporine. Through systematic searches of medical databases we found one ongoing randomised clinical trial investigating total withdrawal of immunosuppressive drugs but, at the time of conducting this review, no trial results on the outcome measures of interest to this review were published. Thus, we cannot reach any conclusion on beneficial or harmful effects of calcineurin inhibitor minimisation for liver transplant recipient patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 14, 2012

Behcet's syndrome is a multisystemic disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement. Treatment of Behcet's syndrome is symptomatic and empirical.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 27, 1998

Focal and segmental glomerulosclerosis (FSGS) is a rare disease whose cause is unknown and is a condition in which the glomeruli leak protein from the blood into the urine. It is described as focal because only some of the glomeruli become scarred (while others remain normal) and segmental as only part of an individual glomerulus is damaged. Over half of all persons with FSGS will develop chronic kidney failure within 10 years. Thus, immunosuppressive strategies are used to control proteinuria and prevent kidney failure. This systematic review identified four studies (108 participants) investigating immunosuppressive treatments for adults with biopsy‐proven FSGS. Adult patients treated with cyclosporin A in combination with prednisone were more likely to achieve partial remission of nephrotic syndrome compared with prednisone alone, however this result is based on only one small study. No data was available on the progression to kidney failure or death.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 16, 2008

Viral infection occasionally triggers myocarditis (inflammation and necrosis of the heart muscle) which can result in serious, acute heart failure. The first signs of this condition may be flu‐like symptoms which evolve into non‐specific chest discomfort, shortness of breath or palpitations. The majority of patients recover spontaneously but others have continuing heart problems which require medication and can be severe enough to cause death.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 18, 2013

Psoriasis is a common chronic skin disease with a prevalence in 2% to 3% of the population, according to European studies. Involvement of the nails occurs in about 50%. Nail psoriasis is difficult to treat, but may respond to some treatments. We aimed to review the efficacy and safety of the treatments used for nail psoriasis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 31, 2013

Kidney transplant recipients need to take several immunosuppressive drugs following surgery to prevent rejection. However, these drugs can cause side effects which compromise long‐term survival for both patients and grafted kidneys.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 12, 2015

Eczema can usually be kept at bay by moisturizing your skin enough, applying anti-inflammatory ointments or creams, and avoiding irritants. If this isn't enough, light therapy with UV rays or treatment with tablets can be considered. Some people have such severe eczema flare-ups that using ointments or creams to reduce the inflammation doesn't relieve the symptoms enough. During acute phases like this, light therapy may be used. If this doesn't work well enough either, tablets that suppress the body's immune response are an option.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 23, 2017

Almost everyone who receives a lung transplant is treated with the drugs tacrolimus or cyclosporin to prevent transplanted organ rejection. Both drugs have serious and common adverse effects. We aimed to compare the use of tacrolimus with cyclosporin to prevent organ rejection after lung transplantation to assess which drug worked best and had fewest adverse effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 31, 2013

After kidney transplantation, patients receive a combination of immunosuppressive medications to prevent rejection of the transplanted kidney. These regimens usually contain a calcineurin‐inhibitor (tacrolimus or cyclosporin A), corticosteroids and an antiproliferative agent (mycophenolic acid (MPA), e.g. mycophenolate mofetil (MMF), or azathioprine (AZA)). MPA is considered to be of stronger immunosuppressive potency than AZA, but the benefits on survival of the graft and its safe use over a long period of time are insufficiently understood.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 3, 2015

Myasthenia gravis (MG) is caused by antibodies produced by the immune system that impair the transmission of nerve impulses to muscles. This results in muscle weakness that characteristically fluctuates. About one person in every 10 000 ‐ 50 000 develops MG each year. The natural history of the disorder is typically a series of exacerbations and remissions. Severe attacks can be life‐threatening because of weakness of muscles involved in swallowing causing choking, and chest muscles causing difficulty with breathing. In MG, immunosuppressant drugs act mainly by reducing the production of antibodies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 17, 2007

Kidney transplants can improve the quality and length of life for patients with end‐stage kidney disease (ESKD) compared with chronic dialysis. To prevent a kidney transplant from being rejected by the body, immune‐system suppressing drugs (most commonly a calcineurin inhibitors (CNI)) are used. CNI are associated with high blood pressure, high lipid levels, an increased risk of developing diabetes, and chronic scarring of the kidney transplant. Chronic kidney scarring is the main reason that kidney transplants lose function in people who do not die before their kidney transplant fails. Belatacept might be an alternative immune‐system suppressing drug which prevents rejection but which also causes fewer side‐effects than CNI.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: November 24, 2014

Almost every liver transplant recipient takes either cyclosporin or tacrolimus to prevent rejection of the graft. This is a review of the clinical trials that compared patients initially prescribed one of the two anti‐rejection drugs after liver transplantation. Sixteen trials (3813 participants) were included. The review shows that tacrolimus is marginally better than cyclosporin at preventing patient death and graft loss. Tacrolimus is substantially better than cyclosporin at preventing rejection. No differences were seen between the drugs with respect to adverse events (renal failure, lymphoproliferative disorder) except for diabetes mellitus, which was more common with tacrolimus. After liver transplantation more patients stayed on tacrolimus than on cyclosporin. Tacrolimus is more beneficial than cyclosporine and should be considered the treatment of choice after liver transplantation. This review does not evaluate the benefit or harm of switching from one anti‐rejection drug to another.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 18, 2006

Idiopathic membranous nephropathy (IMN) is a disease in which glomerular basement membrane becomes thickening by light microscopy on renal biopsy and it represents a major cause of primary nephrotic syndrome in adults. A combined alkylating agent and corticosteroid regimen had short‐ and long‐term benefits on adult IMN with nephrotic syndrome. Among alkylating agents, cyclophosphamide was safer than chlorambucil. It should be emphasised that the number of included randomised studies with high‐quality design was relatively small and most of the included studies did not have adequate follow‐up and enough power to assess the prespecified outcomes. Meanwhile, this regimen was significantly associated with more withdrawals or hospitalisations. Although a six‐month course of alternating monthly cycles of corticosteroids and cyclophosphamide was recommended by the KDIGO Clinical Practice Guideline 2012 as the initial therapy for adult IMN with nephrotic syndrome, clinicians should inform their patients of the lack of high‐quality evidence for these benefits as well as the well‐recognised adverse effects of this therapy. Whether this combined therapy should be indicated in all adult patients at high risk of progression to ESKD or only restricted to those with deteriorating kidney function still remained unclear.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 16, 2014

Sarcoidosis is a condition that can affect most of the organs in the body, including the lungs, heart, brain, bones, liver and skin. Patients who have severe disease or those who do not respond to treatment with steroids are often given powerful agents that suppress the immune system in an attempt to control the disease. However, these drugs have severe side effects. There is no evidence at the moment that the benefits of these drugs outweigh their side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 19, 2006

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