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Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is taken orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease, nephrotic syndrome, eczema, and in organ transplants to prevent rejection. It is also used as eye drops for keratoconjunctivitis sicca (dry eyes).
Read the full article on WikipediaChronic severe dry eye disease with keratitis Clinical criteria: Treatment Phase: Initial treatment for up to the first 180 days of treatment Patient must have a corneal fluorescein staining (CFS) grade of 4 at treatment initiation, using at least one of: (i) the Oxford scale, (ii) the modified Oxford scale, (iii) an equivalent scale to the Oxford scale as determined by the prescriber, AND Patient must have an ocular surface disease index (OSDI) score of at least 23 at treatment initiation, AND The condition must be inadequately controlled by monotherapy with a preservative free artificial tears substitute, AND The treatment must be the sole PBS-subsidised therapy for this condition. Treatment criteria: Patient must be undergoing simultaneous treatment with a preservative free artificial tears substitute, AND Must be treated by an ophthalmologist or by an accredited ophthalmology registrar in consultation with an ophthalmologist; OR Must be treated by an optometrist in accordance with Optometry Board of Australia guidelines, AND Patient must not be undergoing treatment with this drug under this treatment phase beyond day 180 of treatment. Population criteria: Patient must be at least 18 years of age. Prescribing instruction: State in the first authority application for this drug, for the purpose of having a baseline measurement to assess response to treatment under the Continuing treatment listing, each of: (i) the qualifying corneal fluorescein staining grade (a numerical value no less than 4), (ii) the qualifying ocular surface disease index score (a numerical value no less than 23).
Management of transplant rejection Clinical criteria: The treatment must be used by organ or tissue transplant recipients.
Severe atopic dermatitis Clinical criteria: Treatment Phase: Management (initiation, stabilisation and review of therapy) Treatment criteria: Must be treated by a dermatologist; OR Must be treated by a clinical immunologist. The condition must be ineffective to other systemic therapies; OR The condition must be inappropriate for other systemic therapies.
Severe psoriasis Clinical criteria: Treatment Phase: Management (initiation, stabilisation and review of therapy) The condition must be ineffective to other systemic therapies; OR The condition must be inappropriate for other systemic therapies, AND The condition must have caused significant interference with quality of life. Treatment criteria: Must be treated by a medical practitioner who is either: (i) a dermatologist, (ii) a rheumatologist, (iii) general physician; OR Must be treated by a medical practitioner in consultation with one of the above specialist types who is either an accredited: (i) dermatology registrar, (ii) rheumatology registrar. For patients who do not demonstrate an adequate response to ciclosporin, a Psoriasis Area and Severity Index (PASI) assessment must be completed, preferably while on treatment, but no longer than 4 weeks following the cessation of treatment. This assessment will be required for patients who transition to 'biological medicines' for the treatment of 'severe chronic plaque psoriasis'. This assessment must be documented in the patient's medical records.
Nephrotic syndrome Clinical criteria: Treatment Phase: Management (initiation, stabilisation and review of therapy) Patient must have failed prior treatment with steroids and cytostatic drugs; OR Patient must be intolerant to treatment with steroids and cytostatic drugs; OR The condition must be considered inappropriate for treatment with steroids and cytostatic drugs, AND Patient must not have renal impairment. Treatment criteria: Must be treated by a nephrologist.
Severe active rheumatoid arthritis Clinical criteria: Treatment Phase: Management (initiation, stabilisation and review of therapy) The condition must have been ineffective to prior treatment with classical slow-acting anti-rheumatic agents (including methotrexate); OR The condition must be considered inappropriate for treatment with slow-acting anti-rheumatic agents (including methotrexate). Treatment criteria: Must be treated by a rheumatologist; OR Must be treated by a clinical immunologist.
“Ciclosporin's main effect is to lower the activity of T-cells; it does so by inhibiting calcineurin in the calcineurin–phosphatase pathway and preventing the mitochondrial permeability transition pore from opening. Ciclosporin binds to the cytosolic protein cyclophilin (immunophilin) of lymphocytes, especially of T cells. This cyclosporin—cyclophilin complex inhibits calcineurin, which is normally responsible for activating the transcription of interleukin 2. In T-cells, activation of the T-cell receptor normally increases intracellular calcium, which acts via calmodulin to activate calcineurin. Calcineurin then dephosphorylates the transcription factor NF-AT (nuclear factor of activated T-cells), which moves to the T-cell nucleus and increases the transcription of genes for IL-2 and related cytokines. Ciclosporin, by preventing the dephosphorylation of NF-AT, leads to reduced effector T-cell function; it does not affect cytostatic activity.[medical citation needed]”
“variable (about 24 hours)”
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