Oral cyclosporin in psoriasis: a systematic review on treatment modalities, risk of kidney toxicity and evidence for use in non-plaque psoriasis

摘要: Background  Although cyclosporin (CyA) has been in use psoriasis for more than 20 years, there is still controversy regarding treatment strategy, monitoring of kidney function and utility non-plaque psoriasis. Objectives  To prepare evidence-based recommendations concerning the practical CyA psoriasis, we performed a systematic review to better define risk toxicity evidence psoriasis. Methods  A search was on PubMed, Cochrane Embase databases, using key-words ‘psoriasis’, ‘CyA’, ‘nephrotoxicity’ during period from 1980 June 2010. Results  The initial literature identified 428 articles. final selection included 16 randomized controlled trials (RCT) 25 articles (histological studies RCT) 10 (RCT, prospective case series) psoriasis. Higher doses 5 mg/kg produced Psoriasis Area Severity Index (PASI) 75 response between 50 97% patients, whereas lower 2.5 mg/kg yielded PASI 28 85%. could maintain remission at least 3 mg/kg/day. Low calory diet obese patients shown improve efficacy. More 50% treated with may have an increase serum creatinin value over 30% baseline if prolonged 2 years. dose 2.5 mg/kg/day effective 89% palmoplantar pustulosis. erythrodermic obtained significant improvement 3 5 mg/kg/day 2–4 months. etretinate nail psoriasis. Conclusion  Oral indicated plaque pustular or starting associated higher degree clearance. benefit-risk appears be without factors nephrotoxicity: non-obese hypertension aged below 60. ideally suited crisis intervention, continuous maintenance envisaged some provided regularly monitored cumulative duration preferably limited 2 years less.