Neoral can be considered in sight-threatening intermediate or posterior non-infective uveitis that is sight-threatening and has not responded to conventional treatment (usually corticosteroids) or when such treatment is not tolerated.
It can also be used in uveitis associated with Behcet’s disease, a rare autoimmune disorder which causes systemic vasculitis and often presents with ocular problems and membrane ulceration. It can only be used in Behcet’s uveitis if there are repeated inflammatory attacks that threaten the retina and provided there are no neurological manifestations.
For both indications, Neoral should be initiated at 5mg/kg daily in two divided doses and continued until remission of uveal inflammation and an improvement of visual acuity is observed. The initial dose may be increased to 7mg/kg/day for a limited period in refractory cases. To help achieve remission or to counteract inflammatory ocular attacks, adjunctive corticosteroids may be given. For maintenance treatment, the ciclosporin dose should be slowly reduced to the lowest effective dose (max 5mg/kg/day).
No blood drug monitoring required
There is no need to routinely monitor blood ciclosporin levels when treating uveitis but these should be monitored in patients with severe hepatic impairment until stable and within the target range. Monitoring may also be considered if co-administered with drugs that affect the pharmacokinetics of ciclosporin (eg, CYP3A4 inducers, inhibitors or substrates).
Contraindicated in renal impairment
Owing to the nephrotoxic nature of ciclosporin, Neoral should not be used to treat uveitis in patients with renal impairment and renal function must be assessed in all patients before starting (using at least two measurements) and monitored throughout treatment.
View Neoral drug record
Further information: Novartis