Ciclosporin drug monitoring in primary care during COVID-19

The following advice is for the management of patients taking DMARDs for rheumatology related conditions. 

General guidance on management of rheumatology patients during COVID-19 is available from the British Society for Rheumatology.

This page gives advice on drug monitoring in primary care during COVID-19 for ciclosporin when used as a DMARD in stable patients (stable patients are defined as those who have been on current treatment for >12 months and at a stable dose for >6 weeks)

Advice on drug monitoring for other medicines during COVID-19 is here

For ciclosporin, the usual monitoring recommendation is:  

  • 4 weekly monitoring of FBC, calculated GFR, CrCl, ALT and/or AST, albumin, BP and glucose
  • Depending on local policy, people who have been stable for 12 months may be considered for reduced monitoring frequency on an individual basis
  • More frequent monitoring may be appropriate in patients at higher risk of toxicity

During the Covid-19 pandemic, the recommendation to reduce attendances is: 

  • For those on 4 weekly monitoring, consider extending the monitoring interval to between 6 to 8 weeks with specialist advice
  • For those who receive monitoring less frequently, seek specialist advice for extensions to monitoring during the COVID-19 pandemic
  • For those who receive monitoring more frequently due to being at higher risk of toxicity, seek specialist advice for extensions to monitoring during the COVID-19 pandemic

For patients with symptoms of COVID-19, recommendations are:

  • Consider stopping medication (see “Should patients cease their medication as a precaution?” advice from BSR) and seek specialist advice on when to re-start
  • Undertake additional blood tests after self-isolation and within two weeks of re-starting medication
  • If results okay—revert to monitoring at extended interval; if abnormal—seek specialist advice
  • Refer patients to advice from Versus Arthritis

This page was developed in conjunction with Kalveer Flora, Chair, Rheumatology Pharmacists UK (RPUK); Lead Pharmacist, Specialised Rheumatology CRG for NHS England.  We are hugely grateful for her input.

This advice has been developed quickly in response to the COVID-19 pandemic; if you spot anything that’s wrong report a concern to us.