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Cyclosporin in atopic dermatitis: time to relapse and effect of intermittent therapy
Author(s) -
GRANLUND H.,
ERKKO P.,
SINISALO M.,
REITAMO S.
Publication year - 1995
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.1995.tb08633.x
Subject(s) - medicine , atopic dermatitis , gastroenterology , surgery , dermatology
Summary The efficacy of cyclosporin (CyA) in the induction of remission in atopic dermatitis has been documented in controlled studies. However, little information is available on the duration of remission after CyA treatment. We studied the length of remission in 43 patients with severe alopic dermatitis after a 6‐week treatment period with CyA at 5 mg/kg per day. After a follow‐up of 6‐26 weeks, depending on the time‐point of relapse, a second treatment period with CyA, identical to the first, was performed. Disease activity was evaluated bi‐weekly, using six different parameters: 1, a total body disease activity score; 2, the extent of the disease; 3, the occurrence of itch; 4, the occurrence of sleep disturbance; 5, the use of topical emollients; and 6, the use of topical hydrocortisone. A significant decrease in disease activity was observed. The total body disease activity score decreased from the baseline score of 31 to 11.6 at the end of the first part and to 13.4 at the end of the second part of the study. An almost maximal response to treatment was already apparent after 2 weeks of treatment. All the other efficacy parameters studied also showed a significant response to CyA treatment. A similar response to CyA was seen when the patients were re‐treated. After both treatment periods, approximately half of the patients relapsed after 2 weeks (42% first part; 54% second part). After 6 weeks follow‐up, the relapse rates were 71 and 90%. respectively. However, after the first treatment period five patients did not relapse during the 26‐week follow‐up period; the corresponding number was two after the second treatment period. The remission obtained in these seven patients was of clinical relevance, as their mean disease activity score at the end of the follow‐up periods was only 28% (range 11–40) and 43% (both patients), respectively, of their own baseline score. In contrast with the rapid relapse of the dermatitis in the other patients after CyA was stopped, all disease parameters showed improvement when these patients were seen 1 year after the study, i.e. the mean activity score was 17.8 (58% of baseline). All seven patients who did not relapse after the first or second treatment period were still in remission after 1 year, and their mean activity score was only 32% (range 10–69) of their own baseline score. The most common side‐effects were paraesthesiae and gastrointestinal discomfort. CyA dose was reduced in two patients because of drug‐related side‐effects; treatment was stopped prematurely in one patient. The present study confirms the efficacy of CyA in atopic dermatitis. It also suggests that CyA treatment may improve the long‐term outcome of atopic dermatitis, although most patients initially relapsed a few weeks after CyA was stopped.