Background: Although long-term cyclosporine administration may induce toxic effects, it may be the only option for the treatment of severe psoriasis. The objective of the present study was to retrospectively evaluate efficacy and safety of long-term cyclosporine treatment in a cohort of patients affected with moderate to severe psoriasis, recalcitrant or unresponsive to other treatments. Possible risk factors predicting an intolerance to cyclosporine were also investigated. Methods: Data were collected on psoriatic patients treated with cyclosporine for at least 6 months at our Psoriasis outpatient Unit between January 2005 and September 2010. The primary measure for clinical efficacy was the PASI 75 response. Cyclosporine safety was assessed through the review of both laboratory tests and the adverse events registered during the treatment. Results: 20 patients affected with plaque or erythrodermic psoriasis were evaluated. At week 16, the PASI 75 response was achieved by 85% of patients. Adverse events occurred in 8 patients (40%): 4 experienced an increase in serum creatinine levels to more than 30% of their pre-treatment values and 4 developed hypertension. Among these patients, 5 discontinued cyclosporine. Side effects resolved after stopping treatment. Conclusions: Our findings suggest that long-term cyclosporine regimen can be justified in severe psoriasis not responsive to other treatments. When cyclosporine administration is required, obesity, pre-treatment controlled hypertension, increased age (>70 years) and metabolic syndrome should be taken into consideration as a significant correlation with occurrence of cyclosporine-induced side effects has been found.
Prolonged cyclosporine treatment of severe or recalcitrant psoriasis: descriptive study in a series of 20 patients
BORGHI, Alessandro;CORAZZA, Monica;MANTOVANI, Lucia;GIARI, Silvia;VIRGILI, Anna
2012
Abstract
Background: Although long-term cyclosporine administration may induce toxic effects, it may be the only option for the treatment of severe psoriasis. The objective of the present study was to retrospectively evaluate efficacy and safety of long-term cyclosporine treatment in a cohort of patients affected with moderate to severe psoriasis, recalcitrant or unresponsive to other treatments. Possible risk factors predicting an intolerance to cyclosporine were also investigated. Methods: Data were collected on psoriatic patients treated with cyclosporine for at least 6 months at our Psoriasis outpatient Unit between January 2005 and September 2010. The primary measure for clinical efficacy was the PASI 75 response. Cyclosporine safety was assessed through the review of both laboratory tests and the adverse events registered during the treatment. Results: 20 patients affected with plaque or erythrodermic psoriasis were evaluated. At week 16, the PASI 75 response was achieved by 85% of patients. Adverse events occurred in 8 patients (40%): 4 experienced an increase in serum creatinine levels to more than 30% of their pre-treatment values and 4 developed hypertension. Among these patients, 5 discontinued cyclosporine. Side effects resolved after stopping treatment. Conclusions: Our findings suggest that long-term cyclosporine regimen can be justified in severe psoriasis not responsive to other treatments. When cyclosporine administration is required, obesity, pre-treatment controlled hypertension, increased age (>70 years) and metabolic syndrome should be taken into consideration as a significant correlation with occurrence of cyclosporine-induced side effects has been found.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
