Cyclosporine and methotrexate: A dangerous combination

Cyclosporine and psoriasis: 2008 National Psoriasis Foundation Consensus Conference

“…Because methotrexate is hepatotoxic and cyclosporine is metabolized in the liver, and because cyclosporine is nephrotoxic and methotrexate is secreted in the kidneys, at least one group of authors considers the combination dangerous. 66 Nevertheless, several studies have looked at the combination of methotrexate and cyclosporine for psoriasis and psoriatic arthritis. [67][68][69][70][71][72] In a study of methotrexate used with cyclosporine for psoriatic arthritis, there was a reduction in inflammation in patients treated with the combination, but no benefit in pain reduction or improvement in quality of life.…”

Severe exacerbation of psoriasis after cessation of methotrexate therapy successfully treated with cyclosporin A

“…It represents a potential alternative therapy in patients who do not tolerate well high doses of a single drug or whose condition fails to improve sufficiently in response to treatment based on one of the two medications. Combined treatment may lead to more rapid regression of cutaneous lesions, however it should be stressed that such therapy carries a greater risk of adverse reactions, particularly infectious complications [11]. On the other hand, based on the available data [6][7][8][9][10], methotrexate combined with cyclosporin A seems to be a relatively safe therapeutic modality, provided that follow-up examinations are systematically performed and the treatment is monitored on an ongoing basis.…”

“…Stanowi ono potencjalną terapię alternatywną u tych chorych, którzy źle tolerują duże dawki pojedynczego leku lub nie osiągają wystarczającej poprawy przy stosowaniu tylko jednego z nich. Leczenie skojarzone może powodować szybsze ustępowanie zmian skórnych, ale jednocześnie należy pamiętać, że w trakcie takiej terapii wzrasta ryzyko wystąpie-nia ewentualnych działań niepożądanych, zwłaszcza powikłań infekcyjnych [11]. Na podstawie dostępnych danych [6][7][8][9][10] wydaje się jednak, że terapia skojarzona metotreksatem i cyklosporyną A jest stosunkowo bezpieczna, pod warunkiem odpowiedniego nadzoru oraz systematycznego wykonywania i monitorowania badań kontrolnych.…”

New Developments in the Treatment of Psoriasis

“…Cyclosporine and acitretin are inactivated by the same cytochrome P-450 system, which implies that the combination carries the risk of accumulation of cyclosporine [18]. The combination of cyclosporine and methotrexate has been disputed for safety reasons [19]. However, rheumatologists have used the combination with success [20,21].…”

“…New leads in immunomodulatory treatments of psoriasis are under way. At the 2nd Joint International Psoriasis Symposium and European Congress on Psoriasis, June [19][20][21][22][23][24]2001, further developments will be presented. Innovations, not reported so far, are anti-tumor necrosis factor · strategies, anti-ICAM, anti-CD11a, anti-CD80, and anti-IL-8.…”