Long-term low-dose cyclosporine therapy for severe psoriasis: Effects on renal function and structure

Lowe, Nicholas J.; Wieder, Joshua M.; Rosenbach, Alan; Johnson, Kent J.; Kunkel, Robin G.; Bainbridge, Carol; Bourget, Teresa; Dimov, I; Simpson, Karen M.; Glass, Edwin C.; Grabie, Morris T.

doi:10.1016/s0190-9622(96)90726-4

Cited by 104 publications

(71 citation statements)

References 17 publications

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“…According to the literature, lowering the daily dosage (＜3 mg/kg) prevents nephrotoxicity 7 . Other studies have investigated renal function and structure in long-term low dose cyclosporine therapy in psoriasis patients and found only mild structural changes (1∼2 mg/kg/day for 3.5 years) 8 . These side effects could be reduced by using low dose combination therapy.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Trial of Combination Therapy with Etanercept and Low Dose Cyclosporine for the Treatment of Refractory Psoriasis

2010

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Background: Over the past decade, combination therapies have become a mainstay of dermatologic care in psoriasis. Combination therapies are often more effective and safer than large dose single-agent therapies. With the emergence of new biologic therapies, dermatologists now have a wider array of tools to treat psoriasis. Although much data exists regarding cyclosporine or biologic agents alone for psoriasis, little is known about the efficacy, safety and tolerability of combination regimens. Objective: We designed a study to evaluate the efficacy and safety of etanercept and cyclosporin combination therapy in patients with refractory psoriasis. Methods: We administered oral cyclosporine (200 mg daily) and subcutaneous etanercept 50 mg weekly injections until symptoms improved, then maintained treatment at a reduced dose. Seven patients with refractory psoriasis were evaluated 4 weekly. Results: All 7 patients showed rapid responses to combination therapy. Mean Psoriasis Area and Severity Index reductions following conditioning therapy (mean: 6.85 weeks) and maintenance therapy (mean: 56.5 weeks) were 94.9% and 93.2%, respectively. Conclusion: Etanercept and low-dose cyclosporine combination therapy appears to be a safe and efficacious alternative treatment strategy for patients with refractory psoriasis. The combination induced rapid improvement in patients with refractory psoriasis and dramatically improved their quality of life. Clinical studies including larger patient cohort are required to validate the safety and efficacy of this combination therapy. (Ann Dermatol 22(2) 138∼142, 2010)

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Section: Discussionmentioning

confidence: 99%

A Clinical Trial of Combination Therapy with Etanercept and Low Dose Cyclosporine for the Treatment of Refractory Psoriasis

2010

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“…29 The use of these nonbiologic systemic agents for the control of a chronic disease such as psoriasis is complicated by their long-term potential for serious end-organ damage to liver and kidneys, respectively. [30][31][32][33][34] Patients receiving methotrexate and cyclosporine must undergo invasive or frequent laboratory monitoring. 2 Cyclosporine is recommended for short courses of about 3 months duration; long-term use is generally limited to up to 1-2 years due to potential irreversible nephrotoxicity, but rotational regimens can be employed to mitigate this risks.…”

Section: Topical Therapiesmentioning

confidence: 99%

Patient Satisfaction with Psoriasis Therapies: An Update and Introduction to Biologic Therapy

Finlay

Ortonne

2004

J Cutan Med Surg

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“…Of note, at the end of the 6-month follow-up period, PASI scores in relapsers were still lower than baseline values, in each tertiIe. Continuous administration of CsA is associated with tolerability issues, such as arterial hypertension and renal impairment, which appears to be dosedependent and treatment-duration related (20)(21)(22). In order to minimize the risk ofrenal toxicity, short (e.g.…”

Section: Discussionmentioning

confidence: 99%

Psoriasis Relapse Evaluation with Week-End Cyclosporine a Treatment: Results of a Randomized, Double-Blind, Multicenter Study

Colombo¹,

Cassano

Altomare

et al. 2010

Int J Immunopathol Pharmacol

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Cyclosporine A (CsA) effectively controls psoriasis, however, its long-term continuous use is not recommended. This study aims to evaluate the efficacy and tolerability of week-end CsA microemulsion for the reduction of relapse rate in patients with chronic plaque psoriasis who had achieved clinical remission following continuous CsA therapy. The PREWENT (Psoriasis Relapse Evaluation with WeekEnd Neoral Treatment) study was a 24-week, randomized, double-blind, multicenter study, carried out in 22 Italian hospital or university Dermatology units. CsA was discontinued for 8 days previous to the patients being randomized to oral CsA 5 mglkglday or placebo for two consecutive days/week, for a total period of 24 weeks. The primary endpoint was clinical success rate at week 24, defined as the proportion of patients with no clinical worsening (no relapse or a Psoriasis Area and Severity Index [PASI] <75% of pre-treatment PASI). A total of 162 patients were randomized to CsA and 81 to placebo. Clinical success rates at 24 weeks were 66.9% and 53.2% with CsA and placebo, respectively (p = 0.072). Time to first relapse was significantly prolonged with CsA versus placebo (p = 0.023), and PASI was significantly lower from weeks 4 to 16 in CsA recipients. In patients with moderate-severe psoriasis, the clinical success rate was significantly increased with CsA compared to placebo (69.9% vs 46.3%; p = 0.011), and significantly lower increases in PASI were observed from week 4 to week 24 (p < 0.05 vs placebo). CsA was well tolerated, with no differences in mean blood creatinine or blood pressure between CsA and placebo recipients. However, the high withdrawal rate (22.2% of randomized patients), which was not related to side effects, may have led to an overestimation of efficacy, but the study had a good statistical power (88% greater than that observed in similar studies, i.e, 80%). Week-end CsA administration was shown to prolong safely and effectively the time to first relapse in psoriasis patients.Psoriasis is an inflammatory skin condition characterized by chronic recurrent course. T-cell activation and cytokine production playa key role in the formation of skin lesions (1-2). In most patients, the immunosuppressive drug cyclosporine A (CsA) is effective in improving plaque psoriasis (3). The microemulsion formulation of CsA is approved for the treatment of severe psoriasis, when conventional topical treatments are ineffective or inappropriate. The efficacy of CsA microemulsion in psoriasis has been demonstrated in several randomized, controlled clinical trials, with different dosage regimens (4-6).

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Long-term low-dose cyclosporine therapy for severe psoriasis: Effects on renal function and structure

Cited by 104 publications

References 17 publications

A Clinical Trial of Combination Therapy with Etanercept and Low Dose Cyclosporine for the Treatment of Refractory Psoriasis

A Clinical Trial of Combination Therapy with Etanercept and Low Dose Cyclosporine for the Treatment of Refractory Psoriasis

Patient Satisfaction with Psoriasis Therapies: An Update and Introduction to Biologic Therapy

Psoriasis Relapse Evaluation with Week-End Cyclosporine a Treatment: Results of a Randomized, Double-Blind, Multicenter Study

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