Cyclosporin

Oral Presentation-004 Cyclosporine is a Disease-Controlling Antirheumatic Therapy: The Five-Year Results of the GRISAR Study. GF Ferracciolo, E. Marubini, O Della Casa-Alberighi et al. For GRISAR (Gruppo Reumatologi Italiani Studio Artrite Reumatoide); Udine, Italy.

This study began as a one year, randomized, double-blinded study comparing cyclosporine A (CsA) to other disease modifyng agents (DMARDs) in early active rheumatoid arthritis (RA). Patients were continued in the study in an open-label observational study for an additional 4 years. The DMARD group consisted of patients whose initial treatment could be switched to another DMARD or DMARD combination using a step-up strategy based on symptom control or tolerability [antimalarials or auranofin »» parenteral gold salts or sulfasalazine or methotrexate (MTX) »» cyclophosphamide or DMARD combinations]. No patient received MTX, cyclophosphamide or combination DMARDs as first-line therapy.

Editorial Comment: The methodology for this study was confusing. It was begun in 1992 and it is unfortunate that MTX or sulfasalazine was not selected as the DMARD comparator drug. The drugs that were selected for initial treatment (antimalarials and auranofin) have not been convincingly shown to be DMARDs and this may have advantaged the CsA group. Nonetheless, the data are interesting and suggest for the first time that CsA may be a disease modifying agent. However, we will await the full length manuscript to further analyze the validity of the methodology and results.