Cyclosporin a in the treatment of chronic plaque psoriasis: Six years experience

Abstract

Cyclosporin A (CyA) was used to treat 84 patients with severe chronic plaque psoriasis for 1–72 (mean 18.5) months. CyA treatment was effective with a mean (± SEM) reduction in PASI score of 70 ± 8% (P<0.001). The mean maintenance dose required was 3.3 (range 2–5) mg/kg per day. Continuous treatment with CyA was necessary in 32 patients (38%) whereas 33 patients (39%) received either a single or intermittent courses. CyA was ineffective in four patients at the maximum dose (5 mg/kg per day). Hypertension development in 27 patients (32%) but was effectively treated with conventional therapy. Serum creatinine rose from 85 (±2) μmol/l to 98 (±2) μmol/l, a mean increase of 15%. After a mean of 25 (range 3–60) months treatment 17 patients (21%) had > 30% rise in serum creatinine. There was a strong positive correlation between increase in serum creatinine and duration of treatment (r = 0.49; P < 0.001). In 71 patients glomerular filtration rate (GFR) was measured before commencing CyA and fell 16% from 110 (±3) ml/min at baseline to 94 (± 3) ml/min after treatment (P < 0.001). The fall in GFR correlated strongly with the length of treatment (r = 0.41; P < 0.001). Renal biopsies were performed on eight patients receiving long-term continuous CyA. Two biopsies showed features consistent with moderate CyA nephrotoxicity and therapy was discontinued. CyA is effective in the treatment of chronic plaque psoriasis. However, monitoring of renal function is mandatory and significant long-term side-effects may limit its use. (J Dermatol Treat (1993) 4: 3–7)