Abstract
Introduction: Both tacrolimus (Tac) and cyclosporine A (CsA) inhibit phosphatase calcineurin action through different intracellular receptors. Tac has up to a 100-fold stronger inhibitory effect on T cell activation and proliferation in vitro than CsA.
Aims: Our aim was to evaluate the efficacy of switching from CsA to Tac in patients with connective tissue disease-related interstitial lung disease (CTD-ILD) progressing despite combined therapy with prednisolone and CsA.
Methods: We retrospectively assessed the data of patients with CTD-ILD who were switched from CsA to Tac due to deterioration of lung disease between 2007 and 2014. Patients who had at least 3 months of data before and after switching therapy were enrolled in this study.
Results: A total of 12 patients, 6 (50%) polymyositis/dermatomyositis, 3 (25%) rheumatoid arthritis, 2 (17%) systemic sclerosis, and 1 (8%) mixed CTD were included in the analysis. Switching to Tac reduced declines in percentage predicted FVC (-5.0% vs. -0.1%; p=0.02) and diffusion capacity of carbon monoxide of the lung (-3.2% vs. -1.0%; p=0.16). The median change in St. George's Respiratory Questionnaire total score before and after switching to Tac were +5.6 and +1.4, respectively (p=0.27). Ten patients (83%) maintained a stable pulmonary function (%FVC<5% decline) after switching to Tac. This therapy was generally well-tolerated and no serious adverse events were observed.
Conclusions: In patients with CTD-ILD unresponsive to CsA, Tac may be an alternative therapeutic option.
- Copyright ©the authors 2016
