Retrospective Review of Relapse after Systemic Cyclosporine in Children with Atopic Dermatitis

Abstract

Cyclosporine is a systemic therapy used for control of severe atopic dermatitis (AD) in children. Although traditionally recommended at a dose of 5 mg/kg/day for 6 months, a longer duration of treatment may be necessary to bring a child with active and severe disease into remission. There are few data on the short- and long-term effectiveness of longer courses of therapy. This was a retrospective chart review of children treated with cyclosporine at a Canadian hospital-affiliated clinic between 2000 and 2013. Fifteen patients with adequate follow-up were identified. Twelve (80%) were male and the mean age at initiation of cyclosporine was 11.2 ± 3.4 years. The mean duration of cyclosporine therapy was 10.9 ± 2.7 months (range 7-15 months) at a starting dose of 2.8 ± 0.6 mg/kg/day. Of 12 patients (80%) who responded to cyclosporine, 5 patients (42%) had relapsed at a follow-up of 22.7 ± 15.0 months. The duration of therapy was longer in patients who did not relapse (17.7 ± 10.7 months) than in those who did (10.2 ± 2.7 months) (p = 0.06). Adverse events led to discontinuation in three patients (20%) and included infection-related complications in two patients and reversible renal toxicity in one. These results suggest that a longer duration of low-dose cyclosporine may help decrease the risk of relapse in patients with severe AD who are resistant to topical therapies.

Cyclosporine A for severe atopic dermatitis in children. efficacy and safety in a retrospective study of 63 patients

“…According to our results and in agreement with prior studies that assessed the efficacy and tolerability of CSA in children with severe AD, most patients will show a good to excellent response shortly after initiating CSA therapy with a very low incidence of severe side‐effects. We observed a good to excellent outcome in 64% of our patients, a slightly lower figure than previously reported in other studies (Table ). However, as it has been pointed out recently, global assessment on severity scales in AD lack standardized definitions making it difficult to compare studies .…”

“…Acute nephrotoxicity appears during the first weeks or months of treatment and is reversible after lowering the dose or withdrawing CSA, while chronic nephrotoxicity usually occurs from the first year of treatment and is associated with irreversible damage to the kidneys due to tubular atrophy and interstitial fibrosis. In children, CSA is well tolerated and the profile of adverse effects in our series is comparable with other studies . Only two of our patients needed to withdraw from treatment due to pronounced clinical side‐effects (headache and asthenia), but neither showed relevant analytical anomalies.…”

“…Thirty‐six of 41 patients who responded well had withdrawn CSA therapy at the end of our study; 19 of them relapsed after CSA cessation, while the remaining 17 could manage their disease with topical treatments after CSA withdrawal. All but one of the other paediatric series reported a remarkably higher relapse rate . However, some of our patients still had a short follow‐up and the relapse rate could change over time.…”

Long‐term effect of methotrexate for childhood atopic dermatitis

“…A study of the long‐term effects of CyA in 15 children with AD found that 12 (80%) responded to CyA. Of those who responded, five (42%) relapsed, requiring further systemic treatment at 23 months follow‐up, with the authors observing that those treated for a longer duration (>6 months) were less likely to relapse.…”

Atopic Dermatitis in Children: Current Clinical Guidelines for Diagnosis and Therapy

“…При хронизации процесса в воспалительный процесс помимо сохраня-ющейся активности Th 2 -клеток включаются Th 1 -, Th 17 -и Th 22 -клетки.…”