Cyclosporine-A for severe childhood atopic dermatitis: clinical experience on efficacy and safety profile

Abstract

Background/aim: Management of atopic dermatitis (AD) in children is still challenging. The aim of this study was to evaluate the efficacy and safety profile of cyclosporine-A (CsA) treatment in children with severe and recalcitrant AD. Materials and methods: Medical records of 43 children followed between January 2010 and December 2015 and treated with systemic CsA were evaluated retrospectively. Treatment efficacy was assessed according to the physician's global assessment (PGA) score. According to the treatment response, patients were grouped as nonresponder, moderate responder, or good responder. Effects of the variables on treatment response were evaluated by analysis of variance (ANOVA). The safety profile of CsA was assessed by clinical and laboratory findings at each visit. Results: The median initial dose of CsA was 3 mg/kg daily, ranging between 2.5 and 5 mg/kg daily. The mean duration of CsA therapy was 4.9 ± 4.24 months. Seventeen patients (39.5%) achieved good response in a treatment period of 3 to 14 months. After discontinuation of CsA, of the 17 patients, relapse was observed in 4 (23.5%). Moderate response was observed in 12 (27.9%) patients; however, 14 (32.6) patients did not respond to the treatment. Five patients reported mild side effects. Conclusion: Low-dose CsA seems to be an effective and safe treatment option for severe and recalcitrant AD in children.

Monitoring trough levels in cyclosporine for atopic dermatitis: A systematic review

“…Significant creatinine rise in the pediatric trials varied from 0% to 9.3%. Berth‐Jones, Sarıcaoğlu, and Garrido Colmenero all reported no incidence of clinically significant creatinine rise, while Harper, Yee, and Zaki reported 9.3%, 7%, and 5%, respectively. El‐Khalawany reported that 15% of participants developed renal dysfunction; Bunikowski reported 10% had a rise in creatinine (not otherwise defined); and in Hernandez‐Martin's cohort, 3% had a transient rise in urea nitrogen.…”

“…Hernandez‐Martin used a mean initial dose of 4.3 mg/kg. Sarıcaoğlu and Bunikowski used 2.5‐5 mg/kg daily and 2.5 mg/kg, respectively, initially, also titrated to clinical response, and Garrido Colmenero used weekend dosing—5 mg/kg given Saturday and Sunday only. El‐Khalawany administered 2.5 mg/kg daily Figure .…”

“…The nephrotoxic effects of cyclosporine have been reported to occur less frequently in children; in ten trials assessing pediatric atopic dermatitis, there were only 16 cases of renal dysfunction in 318 patients (5%) . There is limited evidence regarding long‐term use of cyclosporine in pediatric populations, with the mean duration of treatment in most of these trials ranging from 6 to 20 weeks.…”

“…To date, there have been no published systematic reviews that examine cyclosporine trough level monitoring in the pediatric atopic dermatitis. In ten trials assessing cyclosporine use in pediatric atopic dermatitis patients, only two performed serological cyclosporine levels . A previous systematic review on the short‐term use of cyclosporine in adult psoriasis patients suggested no monitoring was required for dosing at or below 3 mg/kg daily .…”

Therapeutic Efficacy and Safety of Methotrexate in Moderate-to-Severe Atopic Dermatitis: A Retrospective Study of Korean Patients at Tertiary Referral Hospital

“…Treatment with CsA was successful in approximately 80% of patients with severe or refractory AD 2,3 . Unfortunately, the efficacy of CsA is not long-lasting, and the rapid relapse of AD symptoms is annoying for CsA-treated AD patients following drug withdrawal [2][3][4] . Relapse after discontinuation of CsA was generally observed, with a reported relapse rate of 23.5%∼ 54.8% [2][3][4] and CsA-related rebound phenomena such as systemic CS was detected in 8% of CsA-treated AD patients 2 .…”