Long-term efficacy and safety of cyclosporin in severe adult atopic dermatitis

Abstract

A prospective, open, multicentre study was performed to investigate the efficacy and safety of long-term treatment with cyclosporin in adults with severe atopic dermatitis. Subjects were treated for a maximum of 48 weeks. For the first 8 weeks, cyclosporin was administered at 2.5 mg/kg per day. The dose was then adjusted according to response. Disease activity was monitored using the six-area, six-sign score and the proportion of skin involved. Pruritus and sleep disturbance were assessed using four-point scales. Response was further evaluated on a five-point scale. Adverse events, blood pressure and serum biochemistry were monitored. Tolerability was assessed on a five-point scale. One hundred subjects were enrolled and 65 completed 48 weeks of treatment. Withdrawals occurred due to remission (three), inadequate response (seven), protocol violations (11) and adverse events (14, of which seven were probably treatment related). Cyclosporin produced rapid and highly significant improvements in all indices of disease activity. Sixty-five subjects considered that they had shown a considerable improvement or complete clearance of disease. Most patients relapsed after cessation of treatment, but neither signs nor symptoms had returned to baseline severity 8 weeks later. Blood pressure and serum creatinine levels increased slightly, and in one subject renal impairment was a major factor contributing to withdrawal of the drug. Overall, 85 subjects rated the tolerability of cyclosporin as good or very good. The results indicate that cyclosporin has a place in the long-term treatment of severe atopic dermatitis provided that appropriate patients are selected and careful monitoring is performed.

Telomerase Activity Is Increased and Telomere Length Shortened in T Cells from Blood of Patients with Atopic Dermatitis and Psoriasis

“…This is indirectly supported by the fact that systemic use of cyclosporin, which specifically interrupts IL-2 production by activated T lymphocytes, will reduce or relieve both skin diseases (30,31).…”

Systemic treatment of adult atopic dermatitis

“…Most patients experience a rise in baseline creatinine of approximately 20%. 9 Appropriate patient selection and careful monitoring of creatinine, biochemistry and blood pressure are therefore mandatory throughout treatment. There is also the well documented increased risk of non-melanoma skin cancers (NMSC) in long-term use, further exaggerated in patients who have previously undergone PUVA.…”

Cyclosporine A and its non-immunosuppressive derivative NIM811 induce apoptosis of malignant melanoma cells inin vitro andin vivo studies

“…Cyclosporine A and not related immunosuppressant tacrolimus (FK506) are effective against a broad range of inflammatory skin diseases, including widespread conditions such as psoriasis and atopic dermatitis. [33][34][35][36][37] When applied topically to either mouse or human skin, CsA transport across the cutaneous barrier may be facilitated by using short oligomers of arginine CsA. 38 It raises a possibility of topical application of concentrated CsA or its derivative directly on melanoma tissue to achieve a high dose of the drug that is necessary to exert cytostatic/cytotoxic effects.…”