Neoral (cyclosporin) in dermatology: technical aspects

Cyclosporin is a highly effective treatment for psoriasis, atopic dermatitis and many other inflammatory dermatoses. Absorption of cyclosporin from the traditional Sandimmun formulation is influenced by many factors, including bile flow, food and gastrointestinal motility. As a consequence, the bioavailability of Sandimmun is low and highly variable, both within and between patients. Neoral is a microemulsion preconcentrate formulation that has self-emulsifying properties and immediately forms a microemulsion in aqueous fluids, allowing rapid and consistent absorption of cyclosporin from the gastrointestinal tract. Benefits in dermatology are likely to be more patients responding at lower doses, a faster onset of action and a more predictable response to a given dose allowing for fewer dose adjustments. In the future these benefits of Neoral may lead to the simplified management of cyclosporin treatment and less frequent safety monitoring.