title: Enteric-coated mycophenolate sodium versus cyclosporin A as long-term treatment in adult patients with severe atopic dermatitis: a randomized controlled trial.
abstract: BACKGROUND
  Cyclosporin A (CsA) is frequently used in the treatment of severe atopic dermatitis (AD). Enteric-coated mycophenolate sodium (EC-MPS) may be an alternative with equal efficacy and fewer side effects.
  
  
  OBJECTIVE
  The aim of this observer-blinded randomized controlled trial was to compare EC-MPS with CsA as long-term treatment in adult patients with severe AD.
  
  
  METHODS
  Fifty five patients with AD were treated with CsA (5 mg/kg) in a 6-week run-in period. Thereafter, patients either received CsA (3 mg/kg; n = 26) or EC-MPS (1440 mg; n = 24) during a maintenance phase of 30 weeks and there was a 12-week follow-up period. Disease activity was measured using the objective SCORAD and serum thymus and activation-regulated chemokine (TARC) levels and side effects were registered.
  
  
  RESULTS
  During the first 10 weeks the objective SCORAD and serum TARC levels in the EC-MPS study arm were higher in comparison with the CsA study arm. In addition, 7 of the 24 patients treated with EC-MPS required short oral corticosteroid courses. During maintenance phase disease activity was comparable in both study arms. Side effects in both study arms were mild and transient. After study medication withdrawal, disease activity of the patients in the CsA study arm significantly increased compared with the EC-MPS study arm.
  
  
  CONCLUSIONS
  The nonblinding of patients and prescriber of rescue medication are limitations.
  
  
  CONCLUSIONS
  This study shows that EC-MPS is as effective as CsA as maintenance therapy in patients with AD. However, clinical improvement with EC-MPS is delayed in comparison with CsA. Clinical remission after stopping EC-MPS lasts longer compared with CsA.
authors: Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands. i.haeck@umcutrecht.nl
authors: Inge M
authors: IM
authors: Haeck
authors: Mirjam J
authors: MJ
authors: Knol
authors: Onno
authors: O
authors: Ten Berge
authors: Sara G A
authors: SG
authors: van Velsen
authors: Marjolein S
authors: MS
authors: de Bruin-Weller
authors: Carla A F M
authors: CA
authors: Bruijnzeel-Koomen
mesh_terms: D000328:Adult; D054414:Chemokine CCL17 / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D004791:Enzyme Inhibitors; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013608:Tablets, Enteric-Coated
chemical_list: D054414:Chemokine CCL17; D004791:Enzyme Inhibitors; D007166:Immunosuppressive Agents; D013608:Tablets, Enteric-Coated; D007073:Immunoglobulin E; D016572:Cyclosporine; D009173:Mycophenolic Acid