Topical tacrolimus-a novel treatment alternative for cutaneous chronic graft-versus-host disease

Abstract

Graft-versus-host disease (GVHD) may be resistant to accepted treatments. Therefore, the aim of the present preliminary study was to evaluate the efficacy of topical treatment with tacrolimus, an immunosuppressive agent, for cutaneous GVHD. Ten patients with chronic steroid-dependent cutaneous GVHD were treated with 0.03-0.1 % tacrolimus ointment, twice to three times a day. The dermal manifestations of GVHD were monitored, and a score was given to the cutaneous response by both the physician and patient. Seven patients demonstrated a response to the tacrolimus ointment. Three out of the ten patients were scored as showing a "good" or "complete" response in the objective examiner's view or subjective patient's view. Another four patients showed "moderate" or "mild" response; only three patients showed "no response". Topical tacrolimus is suggested as an alternative treatment for cutaneous chronic steroid-dependent GVHD. This conclusion concurs with a previous study on this medication.

Diretrizes para o diagnóstico, classificação, profilaxia e tratamento da doença enxerto contra hospedeiro crônica

“…Para DECH-c refratária a corticoterapia sistêmica, a fototerapia com UVB de banda estreita (narrow band)/PUVA tem sido empregada com bons resultados. [74][75][76][77] Recentemente, o emprego de inibidores da calcineurina 11,78,79 (pimecrolimo e tacrolimo) tem sido relatado com frequência maior, com o objetivo de melhorar o eritema e prurido, com redução do uso prolongado de esteroides tópicos.…”

“…A literatura oferece diversas opções para o tratamento tópico, 11,[81][82][83][84][85][86][87][88][89][90][91][92][93][94] que estão listadas nas Tabelas 9 e 11.…”

Optimal management of chronic graft‐versus‐host disease in children

“…Some local skin manifestations, especially lichenoid patches or pruritic areas, may improve with topical agents such as tacrolimus (Choi & Nghiem, 2001;Elad et al, 2003) or corticosteroid ointments (Penas et al, 2004). Another approach that can help with lichenoid (but not sclerotic GVHD) is psoralen and UVA light (PUVA) therapy (Penas et al, 2004;Creamer et al, 2007).…”

Treatment of cutaneous chronic graft-versus-host disease with topical pimecrolimus

“…2 Topical tacrolimus has been shown to be effective drug in treating chronic skin GVHD. 3,4 Pimecrolimus, an ascomycin derivative, is a new immunomodulating macrolactam like tacrolimus, and was specifically developed for the treatment of inflammatory skin diseases. The interest in pimecrolimus has been substantial due to its significant anti-inflammatory and immunomodulatory activity coupled with its low systemic immunosuppressive potential.…”