The use of cyclosporine in dermatology: Part II

Ryan, Caitriona; Amor, Karrie T.; Menter, Alan

doi:10.1016/j.jaad.2010.02.062

Cited by 122 publications

(152 citation statements)

References 183 publications

(266 reference statements)

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“…There is marked variability among conventional formulations, and for the microemulsion vs conventional formulations : oral forms of cyclosporin are generally not bioequivalent, (Colombo & Egan, 2010) except for Neoral ® soft gelatin capsules and Neoral ® oral solution, which are bioequivalent (Novartis Pharmaceuticals UK Ltd 2011). Conventional and generic (including generic microemulsion) formulations of cyclosporin are characterised by considerable intra-and inter-individual variability in absorption (Colombo & Egan, 2010;Ryan et al, 2010). By contrast, there is low variability in cyclosporin absorption from the microemulsion Neoral ® preparation, which provides a consistent dose-exposure relationship (Colombo & Egan, 2010).…”

Section: Pharmacokinetic Propertiesmentioning

confidence: 99%

“…Cyclosporin is metabolised by the cytochrome P450 (CYP) system, primarily by isozymes CYP3A4 and CYP3A5 in the liver and small intestine; the p-glycoprotein pump also has a major influence on cyclosporin bioavailability and clearance (Novartis Pharmaceuticals Corporation 2009;Ryan et al, 2010). Cyclosporin is eliminated primarily via the bile.…”

Section: Pharmacokinetic Propertiesmentioning

confidence: 99%

“…Despite such a distinguished clinical history, some dermatologists have been rather hesitant to use cyclosporin because of concerns about possible adverse effects Ryan et al, 2010); however a 'framework' of detailed clinical data now widely supports the effective and safe use of cyclosporin within dermatologists' prescribing guidelines, especially when the drug is used as a 'rescue', or intermittent short-term treatment for severe psoriasis, psoriatic arthritis, or atopic dermatitis .…”

Section: Introductionmentioning

confidence: 99%

“…Another particularly pertinent consideration is that 'conventional' and generic (including generic microemulsion) formulations of cyclosporin are associated with marked intra-and interindividual variability in absorption, thus creating the potential for subtherapeutic dosing at one extreme and toxicity at the other (Colombo & Egan, 2010;Ryan et al, 2010). For this reason, generic formulations have not yet been approved in several countries.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Systemic Cyclosporin in the Treatment of Psoriasis

Colombo¹,

Pietro²

2012

Psoriasis

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Section: Pharmacokinetic Propertiesmentioning

confidence: 99%

Section: Pharmacokinetic Propertiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Systemic Cyclosporin in the Treatment of Psoriasis

Colombo¹,

Pietro²

2012

Psoriasis

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“…Considering the fact that AD is one of the most common skin disorders, the number of AD patients with cyclosporine nephrotoxicity may increase in the future despite the lack of embrace of cyclosporine use by a substantial percentage of the dermatology community [1][2][3], although the prompt recognition of the disease may not be straight forward. Here, we present our experience with such a case in a 26-year-old male Crohn's disease (CD) patient complicated with AD.…”

mentioning

confidence: 99%

Atopic dermatitis, cyclosporine, and nephrotoxicity

et al. 2014

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Cyclosporine has been covered for the treatment for atopic dermatitis (AD) by the health insurance program in Japan since October 2008 [1]. Considering the fact that AD is one of the most common skin disorders, the number of AD patients with cyclosporine nephrotoxicity may increase in the future despite the lack of embrace of cyclosporine use by a substantial percentage of the dermatology community [1][2][3], although the prompt recognition of the disease may not be straight forward. Here, we present our experience with such a case in a 26-year-old male Crohn's disease (CD) patient complicated with AD. He was diagnosed with CD in 2009, when he developed several perianal fistulas requiring surgical drainage and was treated with oral mesalazine (2250 mg/day). At the end of March 2010, infliximab (5 mg/kg) in alternate months was added to his therapeutic regimen due to incomplete control of the disease activity. Thereafter, his clinical remission was maintained; however, he was referred to our hospital at the beginning of August 2012 due to a 5-month history of a moderate decline in his renal function, with a serum creatinine (sCr) level ranging from 1.5 to 2.0 mg/dL. One month before this referral, the administration of infliximab was discontinued. At the initial interview, he reported that he had also been diagnosed with AD in his adolescence, and had been treated by a dermatologist with 100 mg cyclosporine orally twice a day (3.6 mg/kg/day) for 22 months and sporadic oral fexofenadine hydrochloride. The laboratory analysis at the referral revealed a blood urea nitrogen level of 21.5 mg/dL; sCr of 1.4 mg/dL and potassium of 5.4 mmol/L. His urine was negative for protein, and no abnormalities were noted in the sediment. Both kidneys were of normal size and renal cortex echogenicity. There were marginal changes in the sCr level during the outpatient visit despite the infliximab discontinuation, and thus he was subjected to a histological analysis, which revealed arteriolar hyalinization with interstitial fibrosis (Fig. 1), which are characteristic findings of calcineurin inhibitor nephrotoxicity [4]. Finally, we instructed his dermatologist to stop the oral cyclosporine treatment, when the patient's 1 h post-preprandial dose cyclosporine concentration (C1) was 1000 ng/mL. Three months later, his sCr was finally settled around 1.0 mg/dL despite resuming the infliximab administration.One may argue that this kind of diagnostic delay is simply the result of poor skills in the examination and history taking. Nevertheless, the known linkage between renal complications and the therapeutic agents used for inflammatory bowel disease, such as aminosalicylates and infiliximab [5] initially encouraged not only the previous doctor, but also our staff, to attribute the illness of this patient to infiliximab. Although cyclosporine-related renal injury is a well-described clinical entity [4], we should bear in mind that insufficient medical information sharing and the complex nature of comorbidities, which necessitate the use of v...

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