Low‐dose cyclosporin A in the treatment of severe chronic idiopathic urticaria

Abstract

In a limited number of severe chronic idiopathic urticaria (CIU) patients, low-dose cyclosporin A (CsA) treatment was found to be effective. This open study aimed to extend this clinical observation and determine the safety of treatment with CsA. In addition, it aimed to determine the prevalence and characteristics of the autologous serum skin test (AST) in such patients, and whether this test is affected by CsA treatment. Thirty-five patients who suffered from severe CIU (score 3), and who were followed for 6 months (using a clinical urticaria-severity score [range 0-3]) were divided into three groups: 19/35 were treated for 3 months with low-dose CsA, and thereafter followed for an additional 3 months; 6/35 dropped out of protocol treatment; and 10/35 untreated patients (followed for the same period) served as a disease controls. In the treated group, no side-effects were observed, and by the end of treatment, 13/19 (68%) patients were in full remission (score 0) and the remainder scored 1. In contrast, the 10 CsA-untreated patients scored 3 for the whole follow-up period of 6 months. Positive AST was found in 14/35 (40%) of patients, whereas none were detected in 20 healty control subjects. AST neither correlated with disease activity nor predicted response to treatment. This uncontrolled study shows that low-dose CsA is effective in treating CIU patients, and can be given safely for 3 months. However, CIU patients requiring initially high doses of glucocorticosteroids and with a long clinical history are less amenable to CsA treatment.

Hydroxychloroquine in the treatment of anti-histamine refractory chronic spontaneous urticaria, randomized single-blinded placebo-controlled trial and an open label comparison study

“…However, in the previous study, the subjects were not only treated with HCQ, they also received other third line therapy (eg, dapsone, cyclosporine and leukotriene antagonist). Low-dose cyclosporine A in the treatment of severe CSU achieved remission 26-68% (7,8). Vena GA et al reported, after 16 weeks, symptoms scores significantly improved with cyclosporine A treatment group more than placebo, but no patients achieved full remission, and 6% of patients led to discontinuation of treatment due to adverse events (9).…”

Chronic spontaneous urticaria: latest developments in aetiology, diagnosis and therapy

“…Unfortunately outcome measures were not consistent, but taken together cyclosporine A does have a place in the treatment of urticaria although its nephrotoxicity should be given serious consideration before starting treatment [Toubi et al 1997;Ilter et al 1999;Loria et al 2001;Di Gioacchino et al 2003;Baskan et al 2004;Serhat Inaloz et al 2008;Ohtsuka, 2010;Boubouka et al 2011].…”

Treatment of Chronic Urticaria

“…Several authors have described good results with this therapy (105,(115)(116)(117). A limited number of severe CIU patients treated with CsA have been reported in 1997 (116). It was open label study.…”