Cyclosporine Regimens in Plaque Psoriasis: An Overview with Special Emphasis on Dose, Duration, and Old and New Treatment Approaches

Abstract

Cyclosporine A (CsA) is one of the most effective systemic drugs available for the treatment of psoriasis, as evidenced by the results of several randomized studies and by a prolonged experience in dermatological setting. In clinical practice, CsA is usually used for the induction of psoriasis remission at a daily dose included in the range of 2.5–5 mg/kg and with intermittent short-term regimens, lasting on average 3–6 months. The magnitude and rapidity of response are dose dependent, as well as the risk of development of adverse events. Therefore, the dose should be tailored to patient's needs and general characteristics and adjusted during the treatment course according to both the efficacy and tolerability. Some studies support the feasibility of pulse administration of CsA for a few days per week for both the induction and the maintenance of response in psoriasis patients. This paper will review the data on CsA regimens for plaque-type psoriasis and will focus the attention on dose, treatment duration, novel schedules, and role in combination therapies, including the association with biologicals.

The immunogenetics of Psoriasis: A comprehensive review

“…Infiltration of immune cells was noticed, but not considered to be key in pathogenesis, but rather just a consequence of the hyper-proliferating keratinocytes. However, the critical role of the immune system in psoriasis pathogenesis was discovered when administration of immune suppressive agents, such as cyclosporine, denileukin diftitox, and alefacept, proved successful in ameliorating disease [5-8]. Over the next several years, the cellular and molecular contributions to the overactive immune response were further elucidated.…”

Treatment with dietary cyclosporine has no direct effect on myocardial fibrosis and hypertension in mice

“…The primary concern to use cyclosporine in patient is druginduced impairment of renal function due to the dose and duration of cyclosporine administered. 12 A previous retrospective study to evaluate the potential adverse effect of cyclosporine on kidney in patients found that cyclosporine treatment at a dose of 8 mg/kg/ day for one year causes significant damage on kidney, defined as at least moderate focal interstitial fibrosis and large increase in the serum creatinine level. This chronic cyclosporine nephropathy can be minimized when the drug dose was selected in less than 5mg/kg/day.…”

Optimal Treatment Strategies for Control Model of Psoriasis

“…However, it may take from three to four months to reach optimal results. By [2,3,19,20], this time typically varies from 30 to 120 days. The values of other parameters of the system (2.1) and its initial conditions are presented in [19].…”

“…In 1979, researchers discovered on accident that a drug called cyclosporine that suppresses the immune system also clears psoriasis ( [2,12]). This offered one of the first clues that psoriasis was actually an autoimmune disease.…”