Hayriye SARICAOĞLU, Serkan YAZİCİ, Özge ZORLU, Emel BÜLBÜL BAŞKAN, Kenan AYDOĞAN

Cyclosporine-A for severe childhood atopic dermatitis: clinical experience on efficacy and safety profile

Background/aim: Management of atopic dermatitis (AD) in children is still challenging. The aim of this study was to evaluate the efficacy and safety profile of cyclosporine-A (CsA) treatment in children with severe and recalcitrant AD. Materials and methods: Medical records of 43 children followed between January 2010 and December 2015 and treated with systemic CsA were evaluated retrospectively. Treatment efficacy was assessed according to the physician's global assessment (PGA) score. According to the treatment response, patients were grouped as nonresponder, moderate responder, or good responder. Effects of the variables on treatment response were evaluated by analysis of variance (ANOVA). The safety profile of CsA was assessed by clinical and laboratory findings at each visit. Results: The median initial dose of CsA was 3 mg/kg daily, ranging between 2.5 and 5 mg/kg daily. The mean duration of CsA therapy was 4.9 ± 4.24 months. Seventeen patients (39.5%) achieved good response in a treatment period of 3 to 14 months. After discontinuation of CsA, of the 17 patients, relapse was observed in 4 (23.5%). Moderate response was observed in 12 (27.9%) patients; however, 14 (32.6) patients did not respond to the treatment. Five patients reported mild side effects. Conclusion: Low-dose CsA seems to be an effective and safe treatment option for severe and recalcitrant AD in children.

Keywords:

Atopic dermatitis, cyclosporine-A, treatment,

PDF

___

Peters AS, Kellberger J, Vogelberg C, Dressel H, Windstetter D, Weinmayr G, Genuneit J, Nowak D, von Mutius E, Radon K. Prediction of the incidence, recurrence, and persistence of atopic dermatitis in adolescence: a prospective cohort study. J Allergy Clin Immunol 2010; 126: 590-595.
Leung DY, Eichenfield LF, Boguniewicz M. Atopic dermatitis (atopic eczema). In: Wolff K, Goldsmith LA, Katz SI, editors. Fitzpatrick’s Dermatology in General Medicine. 7th ed. New York, NY, USA: McGraw-Hill; 2008. p. 146.
Kanchongkittiphon W, Gaffin JM, Phipatanakul W. Child with atopic dermatitis. Ann Allergy Asthma Immunol 2015; 114: 6-11.
Krakowski AC, Eichenfield LF, Dohil MA. Management of atopic dermatitis in the pediatric population. Pediatrics 2008; 122: 812-824.
Bulbul Baskan E, Yazici S, Tunali S, Sarıcaoglu H. Clinical experience with systemic cyclosporine A treatment in severe childhood psoriasis. J Dermatolog Treat 2016; 27: 328-331.
Slater NA, Morrell DS. Systemic therapy of childhood atopic dermatitis. Clin Dermatol 2015; 33: 289-299.
Hijnen DJ, ten Berge O, Timmer-de Mik L, Bruijnzeel-Koomen CA, de Bruin-Weller MS. Efficacy and safety of long-term treatment with cyclosporin A for atopic dermatitis. J Eur Acad Dermatol Venereol 2007; 21: 85-89.
Berth-Jones J, Finlay AY, Zaki I, Tan B, Goodyear H, Lewis-Jones S, Cork MJ, Bleehen SS, Salek MS, Allen BR et al. Cyclosporine in severe childhood atopic dermatitis: a multicenter study. J Am Acad Dermatol 1996; 34: 1016-1021.
Zaki I, Emerson R, Allen BR. Treatment of severe atopic dermatitis in childhood with cyclosporin. Br J Dermatol 1996; 135: 21-24.
Harper JI, Ahmed I, Barclay G, Lacour M, Hoeger P, Cork MJ, Finlay AY, Wilson NJ, Graham-Brown RA, Sowden JM, et al. Cyclosporin for severe childhood atopic dermatitis: short course versus continuous therapy. Br J Dermatol 2000; 142: 52- 58.
Bunikowski R, Staab D, Kussebi F, Brautigam M, Weidinger G, Renz H, Wahn U. Low-dose cyclosporin A microemulsion in children with severe atopic dermatitis: clinical and immunological effects. Pediatr Allergy Immunol 2001; 12: 216- 223.
Haws S, Shin MK, Haw CR. The efficacy and safety of long- term oral cyclosporine treatment for patients with atopic dermatitis. Ann Dermatol 2010; 22: 9-15.
Sibbald C, Pope E, Ho N, Weinstein M. Retrospective review of relapse after systemic cyclosporine in children with atopic dermatitis. Pediatr Dermatol 2015; 32: 36-40.
Beaumont DR, Arkwright PD. Factors determining the effectiveness of oral cyclosporin in the treatment of severe childhood atopic dermatitis. J Dermatolog Treat 2012; 23: 318- 322.
Hernandez-Martin A, Noguera-Morel L, Bernardino-Cuesta B, Torrelo A, Perez-Martin MA, Aparicio-Lopez C, de Lucas- Collantes C. Cyclosporine A for severe atopic dermatitis in children. Efficacy and safety in a retrospective study of 63 patients. J Eur Acad Dermatol Venereol 2017; 31: 837-842.
Hamid Q, Naseer T, Minshall EM, Song YL, Boguniewicz M, Leung DY. In vivo expression of IL-12 and IL-13 in atopic dermatitis. J Allergy Clin Immunol 1996; 98: 225-231.
Ricci G, Dondi A, Patrizi A, Masi M. Systemic therapy of atopic dermatitis in children. Drugs 2009; 69: 297-306.
Yee GC, Lennon TP, Gonur DJ, Kennedy MS, Deeg HJ. Age dependent cyclosporine pharmacokinetics in marrow transplant recipients. Clin Pharmacol Ther 1986; 40: 438-443.