The effect of oral cyclosporine in the treatment of severe alopecia areata

Açıkgöz, Gürol; Çalışkan, Ercan; Tunca, Mustafa; Yeniay, Yıldıray; Akar, Ahmet

doi:10.3109/15569527.2013.839997

Cited by 34 publications

(17 citation statements)

References 9 publications

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“…Regarding the disease duration, all patients with durations less than 24 months had significant clinical improvement, while patients with disease duration exceeding 24 months showed no response to LD-MTX treatment. Similar to our results, other studies also have suggested that disease duration is an important prognostic factor in AA718.…”

Section: Discussionsupporting

confidence: 93%

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Low-Dose Systemic Methotrexate Therapy for Recalcitrant Alopecia Areata

Lim

Kwon

et al. 2017

Ann Dermatol

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BackgroundAlopecia areata (AA) is an autoimmune skin disease difficult to manage and treat. The pathogenesis of AA features a T-cell-associated autoimmune process, and systemic immunosuppressive therapy is prescribed widely for AA.ObjectiveTo evaluate the efficacy and tolerance of systemic low-dose methotrexate (LD-MTX) therapy in treatment of recalcitrant AA multiplex.MethodsIn a retrospective, non-controlled study, we evaluated 29 patients with recalcitrant AA treated with LD-MTX and assessed the therapeutic response according to severity of disease, disease duration, cumulative dose of MTX, and drug safety.ResultsMTX was administered twice weekly, and the mean maximum weekly dose was 14.48 mg. The response was A5 (regrowth=100.0%) in 14 (48.3%) patients and A4 (regrowth of 75%~90%) in 12 (41.4%) patients. Three patients had poor response to LD-MTX treatment (A2: n=2 [6.9%], A1: n=1 [3.4%]). All three of the patients showing a poor response had disease durations exceeding 24 months. Relapse was observed in 31% of patients with more than 75% regrowth. Common side-effects were elevated liver enzyme levels and gastrointestinal discomfort.ConclusionLD-MTX appears to be an effective and well-tolerated treatment for recalcitrant AA multiplex.

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Section: Discussionsupporting

confidence: 93%

“…Conventional treatments include systemic corticosteroid and local steroid injections234. Immunomodulators such as cyclosporine and azathioprine are also used567. However, some cases of AA remain intractable or experience frequent recurrence necessitating novel treatment options.…”

Section: Introductionmentioning

confidence: 99%

Low-Dose Systemic Methotrexate Therapy for Recalcitrant Alopecia Areata

Lim

Kwon

et al. 2017

Ann Dermatol

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“…This point should be further investigated in prospective research. Maintenance of remission phase is the aim for clinicians and is challenging because of the recurring nature of the disease [38,39]. Gupta et al [33] reported 100% (6/6) recurrence rate of the disease after discontinuation of the CsA monotherapy.…”

Section: Discussionmentioning

confidence: 99%

Cyclosporine With and Without Systemic Corticosteroids in Treatment of Alopecia Areata: A Systematic Review

Nowaczyk

Makowska

Rakowska

et al. 2020

Dermatol Ther (Heidelb)

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Introduction: Cyclosporine is commonly used in treatment for alopecia areata. It can be administered as a monotherapy or in combination with systemic corticosteroids, with various outcomes. Methods: Efficacy of cyclosporine with and without systemic corticosteroids for alopecia areata was evaluated by a systematic review. Cochrane, EBSCOhost, Pubmed, Scopus and Web of Science databases were searched. Only studies published before January 2020 were included. Results: A total of 2104 studies were initially examined, of which 14 were eligible for the systematic review. Among 340 reported cases, 213 had focal, multifocal or ophiasis form of alopecia areata, 60 were diagnosed with alopecia totalis and 67 with alopecia universalis. The mean response rate in the whole group of patients at the end of treatment was 65.00% (221/340; range 25-100%). Hair regrowth rate was higher in the group with cases of alopecia areata limited to scalp (124/165; mean 75.15%; range 40-100%) than in the cases with alopecia totalis (30/46; mean 65.22%; range 25-100%) or alopecia universalis (24/52; mean 46.15%; range 25-100%). The combined therapy with systemic corticosteroids was superior to the monotherapy (152/219; mean 69.41%; 0-80% vs. 69/121; mean 57.02%; range 6.67-100%) and had a lower recurrence rate (39/108; mean 36.11% vs. 34/46; mean 73.91%, respectively). The combined treatment with methylprednisolone was significantly more effective when compared to the cyclosporine monotherapy (124/183; mean 67.76%; range 0-80% vs. 69/121; mean 57.02%; range 6.67-100%). The mean time of treatment was 6.75 months (range 2-36). Limitations: Limitations of our study were the retrospective character of included studies, differences in doses of prescribed drugs, and duration of the treatment and follow-up times. Conclusion: Cyclosporine in combination with oral systemic corticosteroids is more effective than in monotherapy for severe alopecia areata. Key Summary PointsCyclosporine combined with systemic corticosteroids is more effective for alopecia areata than cyclosporine in monotherapy.The combined therapy allows one to reduce dose of cyclosporine.Relapses are less frequently correlated with the combined therapy.Large extend of skin involvement could be a risk factor of a negative treatment response.

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“…In a randomized half-head trial study including patients of recalcitrant AA treated with topical bexarotene, no difference was demonstrated between the two sides [40]. [17,[41][42][43].…”

Section: Topical Bexarotenementioning

confidence: 95%

New Modalities in the Treatment of Refractory Alopecia Areata

Kılıç¹

2017

Hair and Scalp Disorders

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Alopecia areata (AA) is a common and complex T-cell-mediated inflammatory disorder. It may be patchy (localized), involve the entire scalp (alopecia totalis) or entire body (alopecia universalis). Alopecia totalis and universalis are often difficult to treat. Although many therapeutic options currently exist in alopecia areata, none of them are curative or preventive. Besides, none of them are approved by Food and Drug Administration (FDA). The disease unfortunately has an unpredictable course. The factors indicating a poor prognosis are the extent of hair loss at the presentation, long duration of the disease, and ophiasis pattern of hair loss. There are only a few randomized controlled studies conducted on recalcitrant AA. Recent research on immunology of hair follicle and recent developments in immunopathogenesis, together with the shared pathways of the disease with other autoimmune disorders, led investigators to focus on novel therapies that target specific immunological pathways. Herein, we will review shortly the current treatment options in recalcitrant alopecia areata based on recently published studies and then will focus on the recently developed broad-spectrum and targeted therapeutics.

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The effect of oral cyclosporine in the treatment of severe alopecia areata

Abstract: This study indicates that oral cyclosporine treatment may be a beneficial treatment option for severe AA. In addition to this, disease duration is an important prognostic factor that influences efficacy of oral cyclosporine treatment.

Cited by 34 publications

References 9 publications

Low-Dose Systemic Methotrexate Therapy for Recalcitrant Alopecia Areata

Low-Dose Systemic Methotrexate Therapy for Recalcitrant Alopecia Areata

Cyclosporine With and Without Systemic Corticosteroids in Treatment of Alopecia Areata: A Systematic Review

New Modalities in the Treatment of Refractory Alopecia Areata

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