Clinical usefulness and patient satisfaction for treatment with low‐dose cyclosporin administration in patients with moderate psoriasis vulgaris

Abstract

The Japanese guidelines for psoriasis therapy with cyclosporin microemulsion preconcentrate (CyA MEPC) has been revised, and the clinical application of CyA MEPC is being expanded to include mild to moderate psoriasis. In this study, we aimed to confirm the clinical efficiency of low-dose cyclosporin therapy in patients with moderate psoriasis vulgaris. After informed consent was obtained, 19 patients with psoriasis vulgaris were enrolled in this study. Each patient basically administrated CyA MEPC, 2.5 mg/kg/day, orally over 12 weeks. When the psoriasis area and severity index (PASI) score showed a 75% reduction from the initial value, the dosage of CyA MEPC was reduced to 1.5 mg/kg/day and added a topical application of active vitamin D3 ointment. We interviewed the patients as to their satisfaction for the usefulness and cost of the treatment. All patients obtained improvement within 12 weeks. In 10 patients whose PASI score reduced over 75%, we could reduce CyA MEPC dosage. No adverse effects were noted in any patients during the treatment. It is of note that the cost for 1.5 mg/kg/day administration of CyA MEPC was accepted by all the patients. In conclusion, this preliminary study suggests that the CyA MEPC is effective, safe and would provide patients with acceptable costs.

S3 – Guidelines on the treatment of psoriasis vulgaris (English version). Update

“…Eight grade A2 studies [116, 118, 121, 124, 163–165, 172], nine grade B studies [130, 133, 136, 166, 168, 173–176], and three grade C studies [177–179] were included on combination therapy with vitamin D and other topical or systemic therapies. A general distinction may be made between topical combination therapy, combination drugs (i.e., different active ingredients in one preparation), and sequential combinations of different preparations (i.e., agents in two different preparations).…”

“…The resulting evidence level was 1. In regard to combination therapy, seven grade A 2 studies [260], three grade B studies [173, 262, 267], and three grade C studies [177, 268, 269], were included.…”

“…In another study, by Grossman et al (EG C), four out of 34 (12%) patients who were given 2 mg/kg of body weight, achieved complete remission after six weeks [262]. In two Japanese studies, in which some patients had only mild psoriasis, after 12 weeks 45 out of 47 (95.7%) patients who were treated with 3 mg/kg of body weight [265] and 10 out of 19 (52.6%) who were given 2.5 mg/kg of body weight [177] achieved PASI 75.…”

Clinical usefulness of a supplementary cyclosporin administration with a topical application of maxacalcitol ointment for patients with moderate psoriasis vulgaris

“…6 In our previous study, almost all patients whose initial PASI score ranged 12-18 showed a significant improvement and 75% clearance of PASI score within 12 weeks by CyA MEPC administration. 9 Thus, a new strategy can be raised; an intermittent CyA MEPC administration combined with topical vitamin D3 application for patients in the aggressive phase. 9,10 We propose the term "supplementary therapy" for the treatment.…”

Treatment Satisfaction in Psoriasis: Development and Use of the PsoSat Patient Questionnaire in a Cross-Sectional Study

“…Although surveys indicate that patients may frequently remain under ineffective treatment for longer than necessary [7,14,15,16], only few studies have analysed patient satisfaction with health care provision in psoriasis [17,18,19,20]. In the Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) study, van de Kerkhof et al [12] showed that approximately 40% of dermatologists were comfortable, but conservative, in their use of biologic therapy.…”