Περίληψη:
Objective To comparatively assess the impact of intermittent and
continuous cyclosporine (CyA) administration in chronic plaque
psoriasis.
Methods A two-step procedure was followed for the 51 patients who were
randomly assigned in the study. CyA in doses 2.5 mg kg(-1) day(-1)
escalated up to 5 mg kg(-1) day(-1) for efficacy reasons, were given to
all patients during the initial 12-week step. Only patients who achieved
a minimum 50% reduction of baseline PASI could enter the 2nd step,
which lasted for nine additional months. Subjects on the intermittent
schedule stopped all therapy to receive other 12-week course(s) if and
when they relapsed. Patients on the continuous schedule continued CyA
therapy at the lowest, individualized, effective dose.
Results 78% of all patients achieved a PASI-75, with subjects on
continuous treatment manifesting greater improvement (92% vs 62%, P =
0.008). The decrease of DLQI was 89%, without any difference between
the two schedules (P = 0.214). The median effective and maintenance
doses were 3 (2.5-3.8) and 1.8 (0.7-3) mg kg(-1) day(-1), respectively
for intermittent and continuous schedules. A significant correlation was
observed between the clinical parameters and DLQI change at 1 year, for
both groups of patients. Dose modifications for safety reasons were
necessary in 5 patients, but no treatment discontinuation was required.
Patients on the continuous regimen received 139% of the mean cumulative
annual CyA dose of Intermittent therapy.
Conclusion The significantly higher annual cumulative dose required for
the continuous CyA regimen compared to intermittent, leads to the
suggestion that the first modality may offer higher physical improvement
but must remain an option for those patients who do not respond or are
uncooperative with intermittent CyA use.
Συγγραφείς:
Chaidemenos, G. C.
Mourellou, O.
Avgoustinaki, N. and
Papakonstantinou, M.
Karakatsanis, G.
Katsambas, A.
