Combination of glucosamine and low-dose cyclosporine for atopic dermatitis treatment: A randomized, placebo-controlled, double-blind, parallel clinical trial

Abstract

Our recent pilot study showed better outcomes using a combination of low-dose cyclosporine and glucosamine than cyclosporine alone in the treatment of atopic dermatitis (AD). Here, a randomized, placebo-controlled, double-blind, parallel-designed study was planned to compare the efficacy and safety of low-dose cyclosporine and glucosamine combination to low-dose cyclosporine alone for the treatment of patients with moderate to severe AD. AD patients with a Severity Scoring of Atopic Dermatitis (SCORAD) index ≥ 30 were randomly assigned in a 1:1 ratio to receive either cyclosporine 2 mg/kg and glucosamine 25 mg/kg (group A) or cyclosporine and placebo (group B) for 8 weeks. SCORAD indices, serum levels of chemokine ligand 17 and interleukin-31, eosinophil counts, and blood cyclosporine levels were examined before and after treatment. The SCORAD indices for group A (n = 19) were significantly reduced after the treatment and a significant correlation between the changes in the SCORAD indices and changes in the serum levels of chemokine ligand 17, but not interleukin-31, was detected. Glucosamine combined with cyclosporine did not increase adverse events and serum cyclosporine levels compared with cyclosporine alone. Therefore, combination of low-dose cyclosporine and glucosamine may be useful to allow the long-term use of cyclosporine in the treatment of patients with moderate to severe AD.

Glucosamine has an antiallergic effect in mice with allergic asthma and rhinitis

“…In addition, the combination of GlcN and cyclosporine significantly reduced serum IgE, Th2 cytokines, and chemokines in spleen homogenate, and infiltration of eosinophils and mast cells in experimental animals with atopic dermatitis, when compared with cyclosporine alone . Concomitant use of GlcN and cyclosporine in patients with atopic dermatitis also showed significant improvement of clinical symptoms compared with cyclosporine‐only treatment . According to our literature review, this study is the first to evaluate the antiallergic effects of GlcN administration in mice with allergic asthma, and especially rhinitis.…”

“…Therefore, GlcN has been hypothesized to have a therapeutic effect on allergic diseases. Although some animal and human studies have examined the progression of atopic dermatitis after GlcN administration, no studies have evaluated the therapeutic effects of GlcN administration on allergic asthma and rhinitis.…”

Systemic treatments in the management of atopic dermatitis: A systematic review and meta‐analysis

“…We identified trial evidence for 13 systemic treatments available and licensed in Europe: one trial (including 185 patients) evaluated apremilast, 83 three trials (totalling 140 patients) evaluated AZA, 20,28,33,74 three trials (including 1363 patients) evaluated baricitinib, 76,84 19 trials (totalling 820 patients) evaluated CSA, 21‐25,31,32,34,36,37,46,53,54,57,58,75,79‐82 three trials (totalling 85 patients) evaluated corticosteroids, 26,32,45 11 trials (totalling 3529 patients) evaluated dupilumab, 19,35,47,56,71,73,78,85‐88 two trials (totalling 134 patients) evaluated IFN‐γ, 48,50 three trials (totalling 64 patients) evaluated IVIG, 30,46,51 one trial (including 43 patients) evaluated mepolizumab, 29 three trials (totalling 179 patients) evaluated MTX, 22,33,74,75 three trials (totalling 91 patients) evaluated omalizumab, 27,49,72 one trial (totalling 167 patients) evaluated upadacitinib 77 and two trials (totalling 112 patients) evaluated ustekinumab 52,55 . A qualitative overview of included RCTs sorted by treatment is shown in Table 3 for efficacy and Table 4 for safety (Table 3, Table 4).…”

Monitoring trough levels in cyclosporine for atopic dermatitis: A systematic review

“…A total of 2, 515 participants were included across the thirty‐eight trials (see Figure for search strategy results and Table for summary of the trials) . Twenty‐three trials included pediatric participants, and of these, ten focused solely on children . There were 510 participants in these ten pediatric trials, with ages ranging from 2 to 18 years.…”