Combination of glucosamine improved therapeutic effect of low‐dose cyclosporin A in patients with atopic dermatitis: A pilot study

Abstract

Both glucosamine and cyclosporin have been reported to show immunomodulatory effect with inhibition of each different key transcription factor for cytokine gene expression and T-cell function. The overall purpose of this pilot study was to assess the feasibility of the combination of cyclosporin with glucosamine for the treatment of patients with atopic dermatitis. Twelve patients more than 12 years old who required systemic cyclosporin were included in the study. Two of them dropped out due to violation of medication schedule. The single (S) and combination (C) regimens were crossed over every 2 weeks without a washout period between the cross-over for 6 months. Five patients were randomly assigned to the S regimen first (SC sequence), whereas the other five were given the C first (CS sequence). The change of SCORAD index was analyzed as the primary efficacy end-point by general linear model and piecewise linear mixed model. The SCORAD index was reduced with both SC and CS sequence regimens. In particular, index reduction with the C was more than that associated with S regimen; this difference increased as time lapsed. The glucosamine combination was predicted to cause an additive decrease in the mean percent change of the SCORAD index (~6%), with decreasing interleukin (IL)-4 and IL-5 cytokine levels but without increasing treatment-related adverse events. This study suggests that the C would produce better clinical outcomes than the S regimen in patients with atopic dermatitis, although confirmatory clinical trials are warranted to determine the effect of combination.

Scoping systematic review of treatments for eczema

“…A feasibility crossover trial by Kwon and colleagues, 405 reported in 2013, included 10 patients aged > 12 years and compared ciclosporin treatment with and without glucosamine supplementation. Treatments were given once a day for 2 weeks followed by crossover to the other treatment for 2 weeks.…”

“…By combining the severity of eczema SCORAD scores for all 2-week periods on each treatment, the trial by Kwon and colleagues 405 reported that ciclosporin combined with glucosamine was significantly more beneficial than ciclosporin alone from 1.5 months of treatment onwards.…”

“…It is not possible to assess whether or not ciclosporin combined with glucosamine is actually more beneficial than ciclosporin alone as the trial demonstrating a beneficial effect was very small and of an unusual design. 405 This raised doubts about which treatment effect was being measured, the treatment just given or the treatment given in the 2 weeks before, because of a lag in the reduction of the SCORAD score.…”

Therapeutic and immunomodulatory effects of glucosamine in combination with low-dose cyclosporine A in a murine model of imiquimod-induced psoriasis

“…Among these alternative strategies, combination treatments are practical strategies commonly used in patients with psoriasis to increases clinical efficacy, while reducing the risk of cumulative toxicity and sparing the dose of drug (Busard et al, 2014). Recently, we have been developed combination schedules of low-dose CsA plus Glu for use in the treatment of patients with clinical AD and preclinical AD using mouse model (Kim et al, 2013;Kwon et al, 2013). The combination therapy of Glu and low-dose CsA improved the development of AD more effectively than monotherapy with either of the drugs.…”

Combination of glucosamine and low-dose cyclosporine for atopic dermatitis treatment: A randomized, placebo-controlled, double-blind, parallel clinical trial

“…In fact, the combination of glucosamine with low‐dose cyclosporine significantly reduced the clinical scores, with corresponding immune parameter changes, compared with low‐dose cyclosporine alone in an AD mouse model . Additionally, our pilot study, which compared the therapeutic effects of a combination of low‐dose cyclosporine and glucosamine to those of low‐dose cyclosporine alone in AD patients, reported better clinical outcomes with combination treatment . However, the study was performed as an open, repeated, crossover study of single and combination regimens without a washout period.…”