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Maintenance treatment of psoriasis with cyclosporine A: Comparison between continuous and weekend therapy

2013; Elsevier BV; Volume: 68; Issue: 2 Linguagem: Inglês

10.1016/j.jaad.2012.08.013

1097-6787

Iolanda Conde Fernandes, Tiago Torres, Manuela Selores,

Pharmaceutical studies and practices

To the Editor: Since its approval for the treatment of psoriasis in 1997, many trials have confirmed the effectiveness of cyclosporine A (CsA) as both induction and maintenance therapy for moderate to severe disease.1Lebwohl M. Ellis C. Gottlieb A. Koo J. Krueger G. Linden K. et al.Cyclosporine consensus conference: with emphasis on the treatment of psoriasis.J Am Acad Dermatol. 1998; 39: 464-475Abstract Full Text Full Text PDF PubMed Scopus (163) Google Scholar, 2Chaidemenos G.C. Mourellou O. Avgoustinaki N. Papakonstantinou M. Karakatsanis G. Katsambas A. Intermittent vs continuous 1-year cyclosporin use in chronic plaque psoriasis.J Eur Acad Dermatol Venereol. 2007; 21: 1203-1208Crossref PubMed Scopus (11) Google Scholar Nevertheless, it may be associated with serious side effects. Intermittent short-course therapy is used to minimize the risks without a loss of clinical benefits.3Touw C.R. Hakkaart-Van Roijen L. Verboom P. Paul C. Rutten F.F. Finlay A.Y. Quality of life and clinical outcome in psoriasis patients using intermittent cyclosporin.Br J Dermatol. 2001; 144: 967-972Crossref PubMed Scopus (125) Google Scholar A 32-week prospective observational cohort study was conducted with 21 patients given the diagnosis of plaque psoriasis who had a Psoriasis Area and Severity Index (PASI) score above 12. Our aim was to compare 2 different CsA regimens for the maintenance therapy of psoriasis. The baseline assessment included a complete physical examination, blood pressure measurement, and laboratory studies. While on therapy, the patients were monitored at 6, 12, 22, and 32 weeks. We used χ2 and t tests to compare the data. All patients gave their informed consent. Eleven patients were men (52.4%), the mean age was 44.3 ± 9.9 years (range 27-60 years), the mean PASI score was 15.0 ± 2.7 (range 12-23), and the mean body mass index was 26.9 ± 3.5 kg/m2. Associated comorbidities were present in 42.8% of the patients. All patients without contraindications for the drug were treated with CsA 4 mg/kg/d for 12 weeks (induction treatment). PASI 75 was achieved in 19 (90%) patients. The mean PASI score decreased from 15.0 ± 2.7 before CsA treatment to 2.9 ± 1.9 after the induction phase. These 19 patients were randomly allocated to receive either CsA 5 mg/kg/d for 2 consecutive days (on weekends) per week (n = 10) or continued on CsA 2 to 3 mg/kg/d for 20 weeks (maintenance therapy) (n = 9). There were no significant differences between the 2 groups before starting the maintenance phase with regard to the mean PASI score (P = .81), gender, age, body mass index, or comorbidities. During the maintenance therapy, no significant differences in the mean PASI score were reported between the study groups at 22 and 32 weeks (P = .65 and P = .91). Moreover, at the end of the study PASI 75 was achieved by 80% and 75% of the patients on weekend and continuous therapy, respectively. Four patients from the continuous therapy group experienced adverse effects (hypertriglyceridemia, infection, hirsutism, hypertension, and nephrotoxicity) as compared to only 1 in the weekend regimen (acne), although that difference did not achieve statistical significance. The patient who developed uncontrolled hypertension and nephrotoxicity was excluded from the study by the 22nd week. The mean daily dose was higher in the continuous therapy group (2.6 vs 1.4 mg/kg/d) and the twice-weekly dosing schedule was more convenient for patients. The effectiveness of weekend CsA therapy might be explained by its rapid effect on inflammatory and endothelial cells, as evidenced by decreased skin T lymphocytes within 3 days.4Ronzi G. Moggio E. Grasso V. Roveda G. Carugno A. Alborghetti A. et al.Ciclosporina A e week-end therapy nella psoriasi a placche: la nostra esperienza.Boll Soc Med Chir Pavia. 2011; 124: 217-225Google Scholar In psoriasis, the inflammatory recovery time is very slow in comparison with other dermatoses. Therefore, it seems reasonable to discontinue treatment for 3 to 5 days.4Ronzi G. Moggio E. Grasso V. Roveda G. Carugno A. Alborghetti A. et al.Ciclosporina A e week-end therapy nella psoriasi a placche: la nostra esperienza.Boll Soc Med Chir Pavia. 2011; 124: 217-225Google Scholar Furthermore, the liposolubility of CsA allows its storage in adipose tissue and provides higher bioavailability.4Ronzi G. Moggio E. Grasso V. Roveda G. Carugno A. Alborghetti A. et al.Ciclosporina A e week-end therapy nella psoriasi a placche: la nostra esperienza.Boll Soc Med Chir Pavia. 2011; 124: 217-225Google Scholar Both treatment regimens showed comparable results. Despite the limited number of patients, our study suggests that weekend CsA maintenance therapy for psoriasis seems to be a valid option.