Cyclosporine Improves Psoriasis in a Double-blind Study

Abstract

In a double-blind trial, 21 patients with severe plaque psoriasis were randomly assigned to receive oral cyclosporine, 14 mg/kg/d, or its vehicle. After four weeks of therapy the 11 cyclosporine recipients had the following response to treatment: two had total clearing and six improved markedly, two moderately, and one minimally; whereas ten vehicle-treated patients showed no change or minimal improvement. Vehicle-treated patients, after a switch to cyclosporine for four weeks, demonstrated impressive improvement similar to that seen in patients who initially received only cyclosporine. Moderate or marked improvement or total clearing was noted in 17 (81%) of 21 and 20 (95%) of 21 after one and four weeks of therapy, respectively. Mitotic figures and leukotriene B4 levels in lesions decreased 86% and 64%, respectively, after seven days of cyclosporine therapy. Mononuclear (including activated T cells) and polymorphonuclear leukocyte infiltrates were markedly reduced in lesions of all patients after seven days of cyclosporine therapy. These results suggest that psoriasis may have an immunologic basis mediated by activated T cells and/or other immune cells; if a long-term regimen with a favorable efficacy-side effect ratio can be determined, cyclosporine would be a significant advance in the treatment of psoriasis.

Role of neutrophils in induction of acute inflammation in T‐cell‐mediated immune dermatosis, psoriasis: A neutrophil‐associated inflammation‐boosting loop

“…For example, in bone marrow transplants, cells of the immune system may cause the appearance or disappearance of psoriasis (1,2). Furthermore, immunosuppressive agents targeting T cells, such as cyclosporin A, FK506, anti-CD3, anti-CD4 and a toxin specific for interleukin (IL)-2 receptor, were found to induce the improvement of psoriasis (3)(4)(5)(6)(7)(8). These clinical findings indicate that psoriasis is a T-cell-mediated immune dermatosis.…”

Identification of Cellular Pathways of “Type 1,” Th17 T Cells, and TNF- and Inducible Nitric Oxide Synthase-Producing Dendritic Cells in Autoimmune Inflammation through Pharmacogenomic Study of Cyclosporine A in Psoriasis

“…CSA inhibits calcineurin (a calcium-dependent serine/threonine phosphatase) and its substrate, the NFAT (15). Successful treatment of psoriasis with CSA led to the hypothesis that psoriasis was a T cell-mediated disease (16), and subsequently to the development of the new T cell-targeted biological therapies. There are several studies that describe cellular CSA effects in psoriasis.…”

Trends in Type of Original Psoriasis Publications by Decade, 1960 to 2010

“…In particular, studies evaluating cyclosporine and systemic retinoids were frequent. [10][11][12] Since 2000, there has been a marked change in the direction of psoriasis research. The emergence of tumor necrosis factor inhibitor therapy for psoriasis occurred during this period, sparking a series of clinical trials that showed remarkable clinical outcomes and changed the way dermatologists manage psoriasis.…”