Safety of cyclosporin a in HCV-infected patients
Safety of cyclosporin a in HCV-infected patients
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DOI：
10.1196/annals.1423.058
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发表时间：
2007-01-01
期刊：
影响因子：
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通讯作者：
Sebastiani, Gian Domenico
中科院分区：
文献类型：
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作者：
Galeazzi, Mauro;Bellisai, Francesca;Sebastiani, Gian Domenico
由于丙型肝炎病毒（HCV）感染和自身免疫性疾病（ADS）的患病率相对较高，因此在日常临床实践中遇到同时携带HCV的AD患者并不罕见。治疗AD需要皮质类固醇和/或免疫抑制剂药物，但它们使HCV感染患者面临感染恶化的风险。因此，当HCV-RNA也存在时，风湿病学家通常避免在AD中使用皮质类固醇或免疫抑制剂。环孢菌素A（CsA）是一种免疫抑制剂，可用于治疗各种ADS，但大量的体内、体外研究表明，CsA在标准治疗剂量下对HCV复制也有抑制作用。因此，这一证据为改善HCV相关肝病患者（包括移植患者）的治疗和预后开辟了新的途径。最近的报告，虽然数量有限，也表明CsA在治疗AD和合并HCV感染的患者的安全性。在这篇综述中，我们还报告了我们的个人经验，在类风湿关节炎的联合治疗与环孢素A和抗TNF-α药物。
Because of the relatively high prevalence of both hepatitis C virus (HCV) infection and autoimmune disorders (ADS), it is not rare to encounter in daily clinical practice patients with ADs also carrying HCV. Corticosteroids and/or immunosuppressant drugs are needed to treat ADs, but they place HCV-infected patients at risk of worsening the infection. So, rheumatologists have often refrained from using corticosteroids or immunosuppressants in AD when HCV-RNA is also present. Cyclosporin A (CsA) is an immunosuppressive agent used to treat a wide range of ADS, but there is a large evidences in the literature, both in vitro and in vivo, suggesting that CsA also exerts an inhibitory effect on HCV replication at standard therapeutic dose. Therefore, this evidence has opened new ways to improve the therapy and the prognosis in patients with HCV-related liver diseases, including those with transplants. Recent reports, although limited in number, also suggest the safety of CsA in the treatment of patients with AD and concomitant HCV infection. In this review we also report our personal experience on the combination treatment with CsA and anti-TNF-alpha agents in rheumatoid arthritis.