The impact of diabetes and metabolic syndromes to the effectiveness of cyclosporine a pharmacotherapy in psoriatic patients

Abstract

Metabolic diseases concurrent with psoriasis may considerably affect the intensity of its symptoms and therapy efficacy. Cyclosporine A (CsA) is one of the medicines used in conventional therapy of psoriasis. The aim of the study was to determine whether Diabetes 2 and metabolic syndromes influence the efficacy of the CsA therapy in psoriatic patients. The sample group was composed of 32 patients with diagnosed moderate to severe forms of psoriasis vulgaris. The group was divided into subgroups, with regard to concurrently occurring Diabetes 2 and metabolic syndromes. The subgroups were composed of as follows: with diabetes—7 patients, without diabetes—25, with metabolic syndrome—15, without concurrent metabolic syndrome—17, with a metabolic syndrome without diabetes—8 and with both a metabolic syndrome and diabetes—7 patients. The efficacy of therapy was evaluated in each subgroup on the basis of the following scales: PASI, BSA, DLQI on the day of therapy commencing, after 42 and 84 days of the CsA therapy. The statistical analysis was performed with the use of STATISICA 12 (Cracow, Poland; p < .05). The following tests were used: The ANOVA Friedeman test, the posthoc test for ANOVA Friedeman test, the Mann–Whitney U test. We observed clinical improvement measured with PASI BSA scales in each subgroup. The patients themselves also reported improved comfort in their lives, which is confirmed by the lower score in the DLQI scale after 42 and 84 days of the pharmacotherapy. Differences in the values of each scale in a given subgroup turned to be statistically significant. The biggest differences occur after the first 42 days of therapy and they last in the later period of observations. We did not determine any statistically significant differences as a response to treatment in the subgroups subject to comparison. Diabetes and a metabolic syndrome concurrent with psoriasis vulgaris do not affect the efficacy of CsA therapy, which indicates no necessity to modify the standard dosage of the medicine and therapy regime.

The Impact of Hypertension, Diabetes, Lipid Disorders, Overweight/Obesity and Nicotine Dependence on Health-Related Quality of Life and Psoriasis Severity in Psoriatic Patients Receiving Systemic Conventional and Biological Treatment

“…Michalska-Bańkowska et al, observed that concommitant diabetes and a metabolic syndrome did not affect the efficacy of cyclosporine in psoriasis treatment. However, in the study they included thirty-two patients with psoriasis vulgaris, of which seven had coexisting diabetes mellitus, seven patients had both diabetes and metabolic syndrome, and the remaining patients had no comorbidities [ 22 ].…”

Ustekinumab therapy changes the transcriptional activity pattern of TGF-β1–3 genes

“…According to the research conducted by Michalska-Bańkowska et al ., which evaluated the changes in TGF-β1, TGF-β2 and TGF-β3 expression under the influence of cyclosporine A, although the method of handling the test samples was analogous to that described in our own study, other relationships in the transcriptional activity occurring after administration of the drug may be noticed. In the study on cyclosporine A, the expression of both TGF- β 1 and TGF- β 2 after 42 days (6 weeks) decreases, so that in the next stage, it will slightly increase [ 21 ]. On the other hand, in the case of TGF- β 3 , an increase in expression was initially observed, which decreased after 42 days.…”

Non-Alcoholic Fatty Liver Disease (NAFLD) in Patients with Psoriasis: A Review of the Hepatic Effects of Systemic Therapies

“…In a small group of patients with moderate to severe psoriasis, comorbidity with diabetes or metabolic syndrome did not affect the efficacy of cyclosporin. 93 In another clinical study, cyclosporin significantly improved patients’ psoriasis symptoms and this was associated with increased transcription activity of TGFβ1 at the end of treatment in those with or without diabetes, and with or without metabolic syndrome. 112 Through inhibition of the enzyme cyclophilin, cyclosporin has shown beneficial effects on liver fibrosis and cirrhosis in some patients.…”

“…The effects of CYC on TGFβ levels was determined in PSO pts treated for 12 weeks CYC significantly improved PSO symptoms and QoL of pts in this 3-month clinical study. CYC also increased the transcription activity of TGFβ1 at the end of treatment in pts with or without diabetes, and with or without metabolic syndrome [ 93 ] APR Assessment of efficacy, safety and metabolic biomarkers in 113 pts with PSO and/or PsA treated with APR for 1-year Pts with diabetes treated with APR achieved better clinical benefit for their PSO (extent and severity) compared with non-diabetic patients. In addition, after 1 year, blood glucose levels and LDL-C levels were significantly reduced by APR [ 94 ] Effects on inflammatory biomarkers: biological agents ADA A 12-week RCT comparing the effects of ADA, PHO and PLA on vascular inflammation and markers of lipid and glucose metabolism, and inflammation in pts with moderate to severe PSO.…”

“…Assessment of hepatoprotection can be derived from several different research pathways including in vitro experiments, animal models and monitoring of potential biomarkers (Table 3). [89][90][91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108] Given the common etiology of inflammation between psoriasis and NAFLD, it might be postulated that systemic therapies for psoriasis that attenuate systemic inflammation may also have beneficial effects on NAFLD by targeting pro-inflammatory cytokines. 109 However, to date, clinical data are scarce for any direct hepatoprotective effects of systemic psoriasis treatments.…”