The value of monitoring ciclosporin concentration 2 hours post-dose (C2) in dermatology: A prospective cohort study

Abstract

Background: Ciclosporin (CsA) is an effective treatment for several inflammatory dermatoses, including psoriasis and eczema. In contrast to transplantation medicine, dermatologists do not routinely use CsA blood concentrations to guide therapy. Objective: To determine the range of CsA levels at 2 hours after dosing (C2 levels) and whether these C2 levels had any relationship to clinically relevant parameters, such as CsA dose, serum creatinine, blood pressure, PASI (psoriasis area and severity index) or DLQI (dermatology life quality index). Methods: A total of 18 patients on CsA maintenance therapy (cohort 1) and eight patients commencing on CsA (cohort 2) were included in the study. In cohort 1, CsA blood concentrations were measured at 2 hours post-dose on one occasion only, while in cohort 2, C2 levels were performed at baseline and at 4, 8 and 12 weeks after commencing CsA treatment. Results: In cohort 1, a significant relationship between C2 levels and PASI was found. However, no relationship was found between C2 levels and CsA dose, blood pressure, or serum creatinine. In cohort 2, higher C2 levels were associated with lower PASI scores (p < 0.05) and DLQI scores at 4 weeks (p = 0.014). Conclusion: We suggest that C2 levels may be beneficial in patients who are not responding well to CsA treatment in the loading phase.

Key words::

• C2 levels
• ciclosporin
• ciclosporin levels
• psoriasis

Acknowledgements

The authors acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre awarded to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust.

Declaration of interest: Ai-Lean Chew and Saqib J. Bashir report no conflicts of interest. Atholl Johnston owns shares in Novartis AG, has been the recipient of research funding from Novartis and is a paid consultant to the company. Jonathan N. W. N. Barker is on the advisory board to Novartis and is also the lead investigator for a Novartis study (which does not involve ciclosporin). Catherine H. Smith has no current conflicts of interest, but has previously been a consultant to Novartis.