Cyclosporin may establish a niche in immunoregulatory disorders

Cyclosporin looks to be an appropriate choice in psoriasis vulgaris, Behçet's disease or rheumatoid arthritis in patients whose disease is severe and refractory to established therapy.

It may be a suitable as a first-line drug in patients with primary biliary cirrhosis or primary aplastic anaemia, for which there are few other effective treatments.

There are several other conditions in which cyclosporin is effective. However, evidence has come from small comparative or noncomparative studies, or case reports. It is inappropriate at present to recommend the drug unreservedly for these conditions when other treatments are available.

Nephrotoxicity is a major concern when cyclosporin is used. The risk can be minimised by using dosages ≤5 mg/kg/day, and titrating dosage against trough plasma concentrations and serum creatinine levels.