Ciclosporin Side Effects — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyCiclosporin Side EffectsSCE Rheumatology

A 55-year-old woman with severe active rheumatoid arthritis has taken ciclosporin for 4 months. She develops hirsutism and gingival overgrowth. Her blood pressure has risen from 128/78 mmHg to 160/96 mmHg, and her eGFR has fallen from 84 to 60 mL/min/1.73 m² on two measurements. Which adverse effect should be prioritised for ciclosporin dose review and close safety monitoring?

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Correct answer: C — Hypertension with renal dysfunction as the priority toxicity

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · C = shown as D · B = shown as E

E is correct. Ciclosporin can cause hypertension and dose-related renal dysfunction; together these constitute clinically important calcineurin-inhibitor toxicity, unlike hirsutism and gingival hyperplasia, which are generally non-organ-threatening. Here the eGFR has fallen by approximately 29% on two measurements. The UK Neoral SmPC advises reducing the dose by 25–50% when eGFR falls by more than 25% from baseline on repeated measurement, with discontinuation if renal function does not improve within one month. Blood pressure also requires regular monitoring and treatment; persistent uncontrolled hypertension may necessitate discontinuation. Hirsutism (A) and gingival hyperplasia (C) may require symptomatic management but are not the priority safety concern. B is incorrect because ciclosporin requires structured monitoring, and D is incorrect because these adverse effects do not carry equivalent risks.

Reference: Neoral Soft Gelatin Capsules, Summary of Product Characteristics, sections 4.2, 4.4 and 4.8, updated 11 March 2026. https://www.medicines.org.uk/emc/product/1034/smpc