Cyclosporine and tacrolimus are the two calcineurin inhibitors used for managing RA. Clinical studies have shown the efficacy of calcineurin inhibitors as monotherapy or in combination with MTX (Kitahara K & Kawai S 2007). Although the therapeutic effects are similar for these drugs, they differ in adverse reactions. Cyclosporine is an FDA-approved drug for managing RA, whereas tacrolimus is approved in Japan and Korea (Hiroaki M 2013). In India, tacrolimus has not been approved as a DMARD, but it is used less frequently as an off- label drug for treating RA. Cyclosporine is used rarely for managing RA. Though there are studies indicating the usefulness of these two drugs, they are not commonly recommended due to the increased toxicity and the need for monitoring the drug levels constantly (Jasvinder As et al. 2012).

REFERENCES
1. Kitahara K and Kawai S. Cyclosporine and tacrolimus for the treatment of rheumatoid arthritis. Curr Opin Rheumatol. 2007;19(3): p. 238-45.2.
2. Hiroaki M. Small Molecule DMARD Therapy and Its Position in RA Treatment. Innovative Rheumatology. 2013;165-188.
3. Singh JA, Furst DE, Bharat A, Curtis JR, Kavanaugh AF, Kremer JM et al. Update of the 2008 American College of Rheumatology Recommendations for the Use of Disease-Modifying Antirheumatic Drugs andBiologic Agents in the Treatment ofRheumatoid Arthritis. Arthritis Care & Research. 2012;64(5);625- 639.