The value of monitoring ciclosporin concentration 2 hours post-dose (C2) in dermatology: a prospective cohort study.
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.
Chew
Ai-Lean
AL
Skin Therapy Research Unit, St John's Institute of Dermatology, Guy's and St Thomas' Hospital NHS Trust, London, UK.
Bashir
Saqib J
SJ
Johnston
Atholl
A
Barker
Jonathan N W N
JN
Smith
Catherine H
CH
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
D003879:Dermatologic Agents; D016572:Cyclosporine; D003404:Creatinine