Efficacy and safety of preprandial versus postprandial administration of low‐dose cyclosporin microemulsion (Neoral) in patients with psoriasis vulgaris

Abstract

A study of therapeutic drug monitoring indicated that cyclosporin administered before meals produces higher blood concentrations than an equivalent dose administered after meals. Our objective was to compare the efficacy of cyclosporin administered before and after meals, respectively, in psoriasis vulgaris patients. We performed an open trial study. Patients were randomly assigned to receive cyclosporin before (group B, n = 20) or after meals (group A, n = 17), and were followed up in 10 dermatology clinics. The difference between groups was evaluated in severity. The percent reduction in psoriasis area and severity index score from baseline was 29.8% in group A and 75.4% in group B (A vs B, P = 0.00005). Two patients in each group withdrew due to abnormality of laboratory data. Short-term, low-dose treatment with cyclosporin before rather than after meals is suggested as a new effective treatment regimen for psoriasis, with the added advantage of lowering costs.

The use of cyclosporine in dermatology: Part II

“…2,16 This also translates into higher clinical efficacy of the drug, highlighting the importance of taking cyclosporine consistently before or after meals where possible. 17 Cyclosporine has been reported to have a first-pass effect of 27% in the liver. 5 The biphasic distribution of cyclosporine is thought to be caused by the enterohepatic recirculation of cyclosporine from the bile to the small intestine.…”

Cyclosporine and psoriasis: 2008 National Psoriasis Foundation Consensus Conference

“…39 It may be beneficial to recommend patients take cyclosporine before meals, as preprandial compared with postprandial administration has been shown to increase blood concentrations and lead to a more significant reduction in the PASI score. 40 Patients with psoriasis treated with cyclosporine have not been shown to have a higher risk than the general population of developing non-skin malignancy, although appropriately powered studies are needed. 31 Therefore, these patients should continue to undergo the same age-appropriate malignancy screenings that are recommended for the general population.…”

Favorable clinical response by pre-prandial administration of low-dose ciclosporin to severe adult atopic dermatitis

“…Recent pharmacokinetics studies of ciclosporin in psoriasis (8,9) disclosed that pre-prandial administration was recommended because more stable and enhanced ciclosporin absorption can be obtained. High ciclosporin absorption was also obtained in recalcitrant nephrotic syndrome patients by pre-prandial administration (11)(12)(13).…”

“…Although the drug is conventionally administered post-prandially with dosages of 2.5-5 mg/kg or 150-300 mg/day, a recent study of therapeutic drug monitoring (TDM) for psoriasis revealed that pre-prandial ciclosporin administration produced higher blood concentrations (8,9). It was also clarified that area under the concentration curve (AUC) relates to the therapeutic effect, while trough level (C0) relates to the side effects of ciclosporin in psoriatic patients (8,9). Furthermore, a recent report indicates that ciclosporin may increase the regulatory T-cell population at lower administration, which might be responsible for controlling atopic dermatitis (10).…”