Cyclosporin-A Efficacy in Chronic Idiopathic Urticaria

Abstract

Common drugs in the therapy of chronic idiopathic urticaria (CIU) include antihistamines alone or combined with corticosteroids, but severe unresponsive patients require alternative treatments. This retrospective study aims to evaluate clinical response and safety of low-dose and long-term oral Cyclosporin-A (CyA) in unresponsive patients. One hundred and ten CIU patients, unresponsive to a previous treatment (antihistamines plus prednisone 0.2 mg/kg/day), received additional oral CyA 1–3 mg/kg/day for 6 months. The patients were subdivided into three groups (A, B, C) according to the different CyA doses. Parameters of clinical efficacy including pruritus, and size and number of wheals were evaluated at baseline, after three and six months. All adverse events were recorded. The mean total symptom severity score decreased by 63% in Group A, 76% in Group B, and 85% in Group C after 6 months. Total disappearance of the symptoms was recorded in 43 patients (39.1%): 7 (28%) of Group A; 12 (37.5%) of Group B and 24 (45%) of Group C. After a mean of 2 months from CyA suspension, 14 patients (11%) had recurrence of symptoms. Minor side effects were noted in 8 patients (7%). Our study indicates that low-dose, long-term CyA therapy is efficacious and safe in severe unresponsive CIU.

Chronic Urticaria: Indian Context—Challenges and Treatment Options

“…Other treatment options that have significant activity on mediator release on basophils include the calcineurin inhibitor cyclosporin A [55–60], and occasionally ultraviolet therapy [59–62]. As for immunosuppressive therapy with cyclosporin, a recent study suggests that history of hives, shorter duration of urticaria (mean of 55.2 weeks versus 259.6 weeks, P = 0.03), and CU index >10 ( P = 0.05) predict a favorable response to cyclosporin [60].…”

Clinical profile of cyclosporine in dermatology

“…Overall, symptoms totally disappeared for 39% of patients: 28%, 38%, and 45% of patients in the 1‐, 2‐, and 3‐mg/kg/day groups, respectively. Additionally, symptom severity scores reduced by 63%, 76%, and 85%, respectively, and there were no reports of clinically significant safety issues [Di Leo et al, 2011].…”