Cyclosporine clinical management

Blood levels - Blood level monitoring of cyclosporine is a useful and essential component in patient management. While no fixed relationships have been established, blood concentration monitoring may assist in the clinical evaluation of rejection and toxicity, dose adjustments, and the assessment of compliance. 

Immunosuppressive therapy is utilized in chronic severe asthma, where cyclosporine is often effective and sirolimus is another alternative. Omalizumab (anti-IgE antibody) has recently been approved for the treatment of severe asthma (see previous section). Tacrolimus is currently under clinical investigation for the management of autoimmune chronic active hepatitis and of multiple sclerosis, where IFN-3 has a definitive role. 

Treatment of AKC depends on severity of symptoms and the secondary manifestations. Mild clinical manifestations may be managed with environmental controls, cold compresses, vasoconstrictors, and topical antihistamines. However, treatment often includes oral antihistamines, mast cell stabilizers, steroids, and, in more severe cases, cyclosporine. 

Unfortunately, most of the current management strategies for uveitis are borne out of anecdotal and/or empirical approaches. Few if any randomized, controlled, clinical trials exist regarding conventional therapy for uveitis indeed, only a handful of such trials have been identified in the current literature, and most of those focus on the use of systemic cyclosporine. 

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