Sirolimus and
everolimus belong to the novel class of
immunosuppressant agents known as proliferation signal inhibitors (PSIs). They act by preventing
antigen-driven T cell proliferation. While PSIs are widely used in
transplantation, there are few reports of PSI usage in the treatment of autoimmune
rheumatic diseases. The author has presented a series in the APLAR 2006 conference. This report summarizes the clinical experience with PSIs in the treatment of resistant or relapsed
rheumatic diseases where conventional
immunosuppressive agents have failed. This is a retrospective review of patients with various autoimmune
rheumatic diseases who had
sirolimus and
everolimus treatment from the rheumatological clinics of Changi Hospital or the
Arthritis and
Rheumatism Specialist Medical Centre. The period of review was from April 2006 to April 2008. A total of 46 patients were reviewed, 39 females and 7 males. The racial distribution was 33 Chinese, 7 Malays, and 6 Indians. Their disease conditions were as follows: 26 (57%)
rheumatoid arthritis, 7
psoriatic arthritis, 4
systemic lupus erythematosus, 3 scleroderma, 2 anti-Jo-1 syndrome, 2
spondyloarthropathy, 1
MCTD, and 1
vasculitis. All patients had failed at least three DMARDs or
immunosuppressants. Twenty-eight patients received
sirolimus and 28 patients received
everolimus. Overall positive response rate was 48.2%. Twenty-seven percent had adverse events. 20% had no response. 7% relapsed after initial response. PSIs, namely
sirolimus and
everolimus, are a novel class of
immunosuppressants that can be added to the armamentarium of rheumatologists for the treatment of patients with refractory autoimmune
rheumatic diseases.