title: The value of monitoring ciclosporin concentration 2 hours post-dose (C2) in dermatology: a prospective cohort study.
abstract: BACKGROUND
  Ciclosporin (CsA) is an effective treatment for several inflammatory dermatoses, including psoriasis and eczema. In contrast to transplantation medicine, dermatologists do not routinely use CsA blood concentrations to guide therapy.
  
  
  OBJECTIVE
  To determine the range of CsA levels at 2 hours after dosing (C2 levels) and whether these C2 levels had any relationship to clinically relevant parameters, such as CsA dose, serum creatinine, blood pressure, PASI (psoriasis area and severity index) or DLQI (dermatology life quality index).
  
  
  METHODS
  A total of 18 patients on CsA maintenance therapy (cohort 1) and eight patients commencing on CsA (cohort 2) were included in the study. In cohort 1, CsA blood concentrations were measured at 2 hours post-dose on one occasion only, while in cohort 2, C2 levels were performed at baseline and at 4, 8 and 12 weeks after commencing CsA treatment.
  
  
  RESULTS
  In cohort 1, a significant relationship between C2 levels and PASI was found. However, no relationship was found between C2 levels and CsA dose, blood pressure, or serum creatinine. In cohort 2, higher C2 levels were associated with lower PASI scores (p <0.05) and DLQI scores at 4 weeks (p = 0.014).
  
  
  CONCLUSIONS
  We suggest that C2 levels may be beneficial in patients who are not responding well to CsA treatment in the loading phase.
authors.affiliation: Skin Therapy Research Unit, St John's Institute of Dermatology, Guy's and St Thomas' Hospital NHS Trust, London, UK.
authors.forename: Ai-Lean
authors.initials: AL
authors.lastname: Chew
authors.forename: Saqib J
authors.initials: SJ
authors.lastname: Bashir
authors.forename: Atholl
authors.initials: A
authors.lastname: Johnston
authors.forename: Jonathan N W N
authors.initials: JN
authors.lastname: Barker
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy*; D011788:Quality of Life; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D016572:Cyclosporine; D003404:Creatinine