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Safety Considerations with Cyclosporin and Other Systemic Therapy in the Treatment of Severe Psoriasis

A Comparative Overview

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Summary

Management of patients with various forms of severe psoriasis requires knowledge of the therapeutic repertoire and of the risk factors in individual patients. Impairment of renal function in patients treated with cyclosporin is the most critical issue. However, systemic therapy with standard drugs (methotrexate and retinoids) may be limited by other side effects, especially hepatotoxicity.

In the case of cyclosporin, impaired liver function may be regarded as a relative risk. This is due to the fact that cyclosporin is metabolised to a major extent by cells of the small intestine. Studies using cyclosporin for the treatment of psoriasis have not demonstrated liver function impairment as a prominent adverse effect.

Immunosuppressive therapy, as with cyclosporin or methotrexate, increases the risk of later development of malignancies. To minimise the risk for patients, rotation between all systemic therapies may be optimal; however, this may be limited by drug-specific exclusion criteria.

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References

  1. De Rie MA, Meinardi MMHM, Bos JD. Analysis of side-effects of medium- and low-dose cyclosporin maintenance therapy in psoriasis. Br J Dermatol 1990; 123: 347–53

    Article  PubMed  Google Scholar 

  2. Christophers E, Mrowietz U, Henneicke HH, et al. Cyclosporine in psoriasis: a multicenter dose-finding study in severe plaque psoriasis. J Am Acad Dermatol 1992; 26: 86–90

    Article  PubMed  CAS  Google Scholar 

  3. Ellis CN, Gorsulowski DC, Hamilton TA, et al. Cyclosporine improves psoriasis in a double-blind study. JAMA 1986; 256: 3110–6

    Article  PubMed  CAS  Google Scholar 

  4. Ellis CN, Fradin MS, Messana JM, et al. Cyclosporine for plaque-type psoriasis. N Engl J Med 1991; 324: 277–84

    Article  PubMed  CAS  Google Scholar 

  5. Mihatsch MJ, Wolff K. Consensus conference on cyclosporin A for psoriasis February 1992. Br J Dermatol 1992; 126: 621–3

    Article  PubMed  CAS  Google Scholar 

  6. Laburte C, Grossman R, Abi-Rached J, et al. Efficacy and safety of oral cyclosporin A (CyA; Sandimmun) for long-term treatment of chronic severe plaque psoriasis. Br J Dermatol 1994; 130: 366–75

    Article  PubMed  CAS  Google Scholar 

  7. Mrowietz U, Färber L, Henneicke-von Zepelin HH, et al. Longterm maintenance therapy with cyclosporine and post-treatment survey in severe psoriasis, results of a multicenter study. J Am Acad Dermatol 1995. In press

    Google Scholar 

  8. Higgins E, Munro C, Marks J, et al. Relapse rates in moderately severe chronic psoriasis treated with cyclosporin A. Br J Dermatol 1989; 121: 71–4

    Article  PubMed  CAS  Google Scholar 

  9. Powles AV, Carmichael D, Hulme B, et al. Renal function after long-term low-dose cyclosporin for psoriasis. Br J Dermatol 1990; 122: 665–9

    Article  PubMed  CAS  Google Scholar 

  10. Margolis DJ, Guzzo C, Johnson J, et al. Alterations in renal function in psoriasis patients treated with cyclosporine, 5 mg/kg/day. J Am Acad Dermatol 1992; 26: 195–7

    Article  PubMed  CAS  Google Scholar 

  11. Powles AV, Cook T, Hulme B, et al. Renal function and biopsy findings after 5 years’ treatment with low-dose cyclosporin for psoriasis. Br J Dermatol 1993; 128: 159–65

    Article  PubMed  CAS  Google Scholar 

  12. Feutren G, Mihatsch MJ. Risk factors for cyclosporine-induced nephropathy in patients with autoimmune diseases. N Engl J Med 1992; 326: 1654–60

    Article  PubMed  CAS  Google Scholar 

  13. Pei Y, Scholey JW, Katz A, et al. Chronic nephrotoxicity in psoriatic patients treated with low-dose cyclosporine. Am J Kidney Dis 1994; 23: 528–36

    PubMed  CAS  Google Scholar 

  14. Korstantje MJ, Bilo HJG, Stoof TJ. Sustained renal function loss in psoriasis patients after withdrawal of low-dose cyclosporin therapy. Br J Dermatol 1992; 127: 501–4

    Article  Google Scholar 

  15. Powles AV, Baker BS, Fry L. Reversibility of impaired renal function after long-term cyclosporin for psoriasis. Br J Dermatol 1994; 131: 141–2

    Article  PubMed  CAS  Google Scholar 

  16. Olshan AF, Mattison DR, Zwanenburg TSB. Cyclosporine A: a review of genotoxicity and potential for adverse human re-productive and developmental effects. Mutation Res 1994; 317: 163–73

    Article  PubMed  CAS  Google Scholar 

  17. Rosenkranz HS, Klopman G. A structural analysis of the genotoxic and carcinogenic potentials of cyclosporin A. Mutagenesis 1992; 7: 115–8

    Article  PubMed  CAS  Google Scholar 

  18. Walz MK, Albrecht KH, Niebel W, et al. De-novo-Malignome unter medikamentöser Immunsuppression. Dtsch Med Wochenschr 1992; 117: 927–34

    Article  PubMed  CAS  Google Scholar 

  19. Arellano F, Krupp P. Malignancies in rheumatoid arthritis patients treated with cyclosporin A. Br J Rheumatol 1993; 32Suppl. 1: 72–5

    PubMed  Google Scholar 

  20. Bagot M, Dubertret L. Lymphocytic infiltrates of the skin in association with cyclosporine therapy. J Am Acad Dermatol 1992; 26: 283

    Article  PubMed  CAS  Google Scholar 

  21. Brown MD, Ellis CN, Billings J, et al. Rapid occurrence of nodular cutaneous T-lymphocyte infiltrates with cyclosporine therapy. Arch Dermatol 1988; 124: 1097–100

    Article  PubMed  CAS  Google Scholar 

  22. Gupta AK, Cooper KD, Ellis CN, et al. Lymphocyte infiltrates of the skin in association with cyclosporine therapy. J Am Acad Dermatol 1990; 23: 1137–41

    Article  PubMed  CAS  Google Scholar 

  23. Ryffel B. The carcinogenicity of ciclosporin. Toxicology 1992; 73: 1–22

    Article  PubMed  CAS  Google Scholar 

  24. Stern RS, Laird N. The carcinogenic risk of treatments for severe psoriasis. Cancer 1994; 73: 2759–64

    Article  PubMed  CAS  Google Scholar 

  25. Mark AL. Cyclosporine, sympathetic activity, and hypertension. N Engl J Med 1990; 323: 748–50

    Article  PubMed  CAS  Google Scholar 

  26. Feutren G, Abeywickrama K, Friend D, et al. Renal function and blood pressure in psoriatic patients treated with cyclosporin A. Br J Dermatol 1990; 122Suppl. 36: 57–69

    Article  PubMed  Google Scholar 

  27. Grossman RM, Delaney RJ, Brinton EA, et al. Hypertriglyceridemia in patients with psoriasis treated with cyclosporine. J Am Acad Dermatol 1991; 25: 648–51

    Article  PubMed  CAS  Google Scholar 

  28. Stiller MJ, Pak GH, Kenny C, et al. Elevation of fasting serum lipids in patients treated with low-dose cyclosporine for severe plaque-type psoriasis. J Am Acad Dermatol 1992; 27: 434–8

    Article  PubMed  CAS  Google Scholar 

  29. Mrowietz U, Färber L, Bachmann H, et al. Hypertriglyceridemia in patients with psoriasis treated with cyclosporine. J Am Acad Dermatol 1992; 27: 491–2

    Article  PubMed  CAS  Google Scholar 

  30. Handelsman DJ, McDowell IFW, Caterson ID, et al. Ovarian function after renal transplantation: comparison of cyclosporin A with azathioprine and prednisone combination regimens. Br J Obstet Gynaecol 1984; 91: 802–7

    Article  PubMed  CAS  Google Scholar 

  31. Handelsman DJ, McDowell IFW, Caterson ID, et al. Testicular function after renal transplantation: comparison of cyclosporin A with azathioprine and prednisone combination regimes. Clin Nephrol 1984; 22: 144–8

    PubMed  CAS  Google Scholar 

  32. Haberman J, Karwa G, Greenstein SM, et al. Male fertility in cyclosporine-treated renal transplant patients. J Urol 1991; 145: 294–6

    PubMed  CAS  Google Scholar 

  33. Armenti VT, Ahlswede KM, Ahlswede BA, et al. National transplantation pregnancy registry-outcomes of 154 pregnancies in cyclosporine-treated female kidney transplant recipients. Transplantation 1994; 57: 502–6

    PubMed  CAS  Google Scholar 

  34. Wright S, Glover M, Baker H. Psoriasis, cyclosporine, and pregnancy. Arch Dermatol 1991; 127: 426

    Article  PubMed  CAS  Google Scholar 

  35. Birkeland SA, Elbirk A, Rohr N, et al. Cyclosporine monotherapy in children: long-term effect. Transplant Proc 1994; 26: 2610–6

    PubMed  CAS  Google Scholar 

  36. Brodehl J. Consensus statements on the optimal use of cyclosporine in pediatric patients. Transplant Proc 1994; 26: 2759–62

    PubMed  CAS  Google Scholar 

  37. Feutren G, Friend D, Timonen P, et al. Cyclosporin monitoring in psoriasis. Lancet 1990; 335: 866–7

    Article  PubMed  CAS  Google Scholar 

  38. Feutren G, Friend D, Timonen P, et al. Predictive value of cyclosporin A level for efficacy or renal dysfunction in psoriasis. Br J Dermatol 1990; 122Suppl. 36: 85–93

    Article  PubMed  Google Scholar 

  39. Grossman RM, Thivolet J, Claudy A, et al. A novel therapeutic approach to psoriasis with combination calcipotriol ointment and very low-dose cyclosporine: results of a multicenter placebo-controlled study. J Am Acad Dermatol 1994; 31: 68–74

    Article  PubMed  CAS  Google Scholar 

  40. Korstantje MJ, Van Breda Vriesman CJP, Van de Staak WJBM. Cyclosporine and methotrexate: a dangerous combination. J Am Acad Dermatol 1990; 23: 320–1

    Article  Google Scholar 

  41. Brechtel B, Wellenreuther U, Toppe E, et al. Combination of etretinate with cyclosporine in the treatment of severe recalcitrant psoriasis. J Am Acad Dermatol 1994; 30: 1023–4

    Article  PubMed  CAS  Google Scholar 

  42. Salomon D, Mesheit J, Masgrau-Peya E, et al. Acitretin does not prevent psoriasis relapse related to cyclosporin A tapering. Br J Dermatol 1994; 130: 257–8

    Article  PubMed  CAS  Google Scholar 

  43. Roenigk HH, Auerbach R, Maibach HI, et al. Methotrexate in psoriasis: revised guidelines. J Am Acad Dermatol 1988; 19: 145–56

    Article  PubMed  Google Scholar 

  44. Hills RJ, Ive FA. Folinic acid rescue used routinely in psoriatic patients with known methotrexate ‘sensitivity’. Acta Derm Venereol (Stockh) 1992; 72: 438–40

    CAS  Google Scholar 

  45. Zachariae H. Methotrexate side-effects. Br J Dermatol 1990; 122Suppl. 36: 127–33

    Article  PubMed  Google Scholar 

  46. Kremer JM, Alarcón GS, Lightfoot RW, et al. Methotrexate for rheumatoid arthritis. Arth Rheum 1994; 37: 316–28

    Article  CAS  Google Scholar 

  47. Van Dooren-Greebe RJ, Kuijpers ALA, Mulder J, et al. Methotrexate revisited: effects of long-term treatment in psoriasis. Br J Dermatol 1994; 130: 204–10

    Article  PubMed  Google Scholar 

  48. Zachariae H, Sögaard H. Methotrexate-induced liver cirrhosis. Dermatologica 1987; 175: 178–82

    Article  PubMed  CAS  Google Scholar 

  49. Gollnick HPM, Orfanos CE. Clinical efficacy of etretinate and acitretin: European experience. In: Roenigk HH, Maibach HI, editors. Psoriasis. New York: Marcel Dekker, 1991; 725–48

    Google Scholar 

  50. Halioua B, Saurat J-H. Risk:benefit ratio in the treatment of psoriasis with systemic retinoids. Br J Dermatol 1990; 122Suppl. 36: 135–50

    Article  PubMed  Google Scholar 

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  1. Department of Dermatology, University of Kiel, Schittenhelmstr. 7, D-24105, Kiel, Germany

    Ulrich Mrowietz

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Mrowietz, U. Safety Considerations with Cyclosporin and Other Systemic Therapy in the Treatment of Severe Psoriasis. Clin. Drug Invest. 10 (Suppl 1), 36–44 (1995). https://doi.org/10.2165/00044011-199500101-00007

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