Oral Cyclosporine Weekend Therapy: A New Maintenance Therapeutic Option in Patients with Severe Atopic Dermatitis

Abstract

Cyclosporine A (CyA) is a systemic therapy used to control severe atopic dermatitis (AD) in children, but its use may be associated with serious side effects. Intermittent short-course therapy has been used to minimize these risks without the loss of clinical benefits. We conducted a 20-week study using intermittent short-course CyA therapy in five patients with severe AD and a Scoring Atopic Dermatitis (SCORAD) score >40. The result was a reduction in the cumulative dose of CyA and serum CyA level, which allows for a longer duration of CyA treatment and decreases the risk of relapse in patients with severe AD.

Monitoring trough levels in cyclosporine for atopic dermatitis: A systematic review

“…Significant creatinine rise in the pediatric trials varied from 0% to 9.3%. Berth‐Jones, Sarıcaoğlu, and Garrido Colmenero all reported no incidence of clinically significant creatinine rise, while Harper, Yee, and Zaki reported 9.3%, 7%, and 5%, respectively. El‐Khalawany reported that 15% of participants developed renal dysfunction; Bunikowski reported 10% had a rise in creatinine (not otherwise defined); and in Hernandez‐Martin's cohort, 3% had a transient rise in urea nitrogen.…”

“…Hernandez‐Martin used a mean initial dose of 4.3 mg/kg. Sarıcaoğlu and Bunikowski used 2.5‐5 mg/kg daily and 2.5 mg/kg, respectively, initially, also titrated to clinical response, and Garrido Colmenero used weekend dosing—5 mg/kg given Saturday and Sunday only. El‐Khalawany administered 2.5 mg/kg daily Figure .…”

“…The nephrotoxic effects of cyclosporine have been reported to occur less frequently in children; in ten trials assessing pediatric atopic dermatitis, there were only 16 cases of renal dysfunction in 318 patients (5%) . There is limited evidence regarding long‐term use of cyclosporine in pediatric populations, with the mean duration of treatment in most of these trials ranging from 6 to 20 weeks.…”

“…To date, there have been no published systematic reviews that examine cyclosporine trough level monitoring in the pediatric atopic dermatitis. In ten trials assessing cyclosporine use in pediatric atopic dermatitis patients, only two performed serological cyclosporine levels . A previous systematic review on the short‐term use of cyclosporine in adult psoriasis patients suggested no monitoring was required for dosing at or below 3 mg/kg daily .…”

Non-topical management of recalcitrant paediatric atopic dermatitis

“…The use of ciclosporin over the weekend,36 akin to topical proactive treatment, as a maintenance therapy to reduce the risk of relapse was also explored.…”