Long-term continuous versus intermittent cyclosporin: therapy for psoriasis

Area of Science:

• Dermatology
• Immunosuppressive Therapy

Background:

• Psoriasis is a chronic inflammatory skin condition requiring long-term management.
• Cyclosporin A (CyA) is an effective immunosuppressant for moderate to severe psoriasis.
• Optimal long-term dosing strategies for CyA in psoriasis remain under investigation.

Purpose of the Study:

• To compare the long-term efficacy and safety of continuous versus intermittent cyclosporin A (CyA) regimens for psoriasis.
• To evaluate adverse events and disease control over an extended follow-up period.

Main Methods:

• A multicenter randomized controlled study followed 31 psoriasis patients for at least 48 months.
• Patients received either continuous CyA therapy or intermittent CyA with topical corticosteroids.
• Psoriasis Area and Severity Index (PASI) scores and adverse events were monitored.

Main Results:

• Both continuous and intermittent CyA regimens significantly reduced PASI scores by over 70% from baseline.
• Long-term PASI scores were maintained between 5-12 points for both groups, with no significant difference in response rates.
• Continuous therapy showed slightly better overall psoriasis control, but intermittent therapy had fewer reported malignancies and renal impairment in elderly patients.

Conclusions:

• Cyclosporin A demonstrates long-term efficacy and tolerability for psoriasis under both continuous and intermittent regimens.
• Intermittent therapy may be preferable due to potential malignancy risks associated with continuous CyA, despite slightly lower efficacy.
• Further research is needed to optimize intermittent CyA protocols for safety and efficacy comparable to continuous therapy.