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Can maintenance cyclosporine be used in psoriasis without decreasing renal function?
A K Silverman1, M Emmett, A Menter
1Baylor Psoriasis Center, Baylor University Medical Center, Dallas, TX 75246.
Insights
Cyclosporine therapy for psoriasis is generally safe at doses below 5 mg/kg/d for healthy individuals. Regular monitoring of kidney function and blood pressure is recommended for long-term treatment.
Area of Science:
- Nephrology
- Dermatology
- Pharmacology
Background:
- Cyclosporine is an immunosuppressive drug used in treating psoriasis.
- Nephrotoxicity is a known potential side effect of cyclosporine therapy.
- Dose dependency of cyclosporine's nephrotoxicity is established.
Purpose of the Study:
- To evaluate the risk of nephrotoxicity in psoriasis patients undergoing cyclosporine treatment.
- To establish guidelines for monitoring renal function during cyclosporine therapy for psoriasis.
- To determine safe dosage thresholds and monitoring frequencies for cyclosporine in psoriasis management.
Main Methods:
- Review of existing literature on cyclosporine-induced nephrotoxicity in psoriasis.
- Analysis of dose-response relationship between cyclosporine and renal function.
- Recommendations for monitoring serum creatinine, urea nitrogen, blood pressure, and glomerular filtration rate (GFR).
Main Results:
- Nephrotoxicity is unlikely at cyclosporine doses below 5 mg/kg/d in healthy psoriasis patients.
- Regular monitoring of renal function (urea nitrogen/creatinine) and blood pressure is crucial for long-term protocols.
- Yearly GFR measurement is advised for otherwise healthy psoriasis patients, particularly the elderly or those with diabetes.
Conclusions:
- Low-dose cyclosporine protocols for psoriasis do not show convincing evidence of irreversible renal dysfunction.
- Cyclosporine, even at low doses, requires careful monitoring; it is not considered entirely safe.
- Proposed monitoring schedule includes GFR at 3, 6, and 12 months, with more frequent checks and dose adjustments if serum creatinine increases by over 30%.
Abstract:
Nephrotoxicity attributable to cyclosporine therapy is dose dependent and unlikely to occur in psoriasis treatment protocols using less than 5 mg/kg/d in otherwise healthy patients. Any long-term or maintenance protocol should include regular monitoring of urea nitrogen/creatinine levels and blood pressure. Cyclosporine is a potent drug, and it is reasonable to monitor its administration to otherwise healthy psoriasis patients with yearly measurement of glomerular filtration rate (GFR), especially in elderly patients or patients with diminished renal reserve (eg, diabetes). There is no convincing evidence of irreversible renal dysfunction in psoriasis patients on low-dose cyclosporine protocols, nor is there evidence that cyclosporine in low doses in completely safe or banal. Therefore, we suggest monitoring GFR at 3, 6, and 12 months after initiating therapy, provided serum creatinine level is stable. If serum creatinine level increases by > 30% over baseline, GFR should be monitored more frequently and the dose of cyclosporine adjusted if there is a persistent decrease.