The Effect of Oral Cyclosporine A on Immune Indicators and Pregnancy Outcomes in Patients With Adverse Pregnancies: A Retrospective Study

AIM: The use of low-dose cyclosporine A (CsA) has been shown to increase live birth rates in cases of unexplained recurrent spontaneous abortions, without causing significant side effects for the pregnant woman or fetus. The primary aim of this study was to evaluate the effect of CsA on immune system indicators and pregnancy success in adverse pregnancies. METHODS: Data were collected from patients diagnosed with adverse pregnancies caused by immune-related abnormalities at the Department of Rheumatology and Immunology in a tertiary hospital in Shenzhen, China, between September 2023 and October 2024. Information collected included patient details, cytokine levels, lymphocyte subpopulations, blocking antibody changes, and CsA blood concentration during medication. This helped determine the effective blood concentration range of CsA for these patients, aimed at enhancing the drug's safety and effectiveness. OUTCOME: The study included a total of 661 participants, among whom 279 achieved successful pregnancies after CsA treatment (A clinically confirmed pregnancy is considered a successful pregnancy). The CD3+, CD4+, and CD8+ blocking antibody efficiency levels were significantly increased after CsA administration (P < 0.001, p = 0.003, p = 0.017), and the former two changes were strongly correlated with pregnancy success (p = 0.002, P < 0.001). The receiver operating characteristic (ROC) curve revealed that increases in CD3+, CD4+ blocking antibodies were strong predictors of successful pregnancy outcomes. Cytokine levels, including IL-2, IL-4, IL-6, IL-10, IL-17, IFN-γ, and TNF-α, decreased significantly after treatment (P < 0.01). Ratios such as IL-2/IL-10 and IFN-γ/IL-10 also showed significant reductions (P < 0.001), while the IFN-γ/IL-4 and TNF-α/IL-4 ratios increased significantly (P < 0.001). The majority of patients had blood CsA concentrations between 10-70 ng/mL. CONCLUSION: These findings suggest that CsA can effectively regulate immune markers and restore immune balance, reducing the impact of immune-related adverse pregnancy outcomes.