title: Prolonged cyclosporine treatment of severe or recalcitrant psoriasis: descriptive study in a series of 20 patients.
abstract: BACKGROUND
  Although long-term cyclosporine administration may induce toxic effects, it may be the only option for the treatment of severe psoriasis. The objective of the present study was to retrospectively evaluate efficacy and safety of long-term cyclosporine treatment in a cohort of patients affected with moderate to severe psoriasis, recalcitrant or unresponsive to other treatments. Possible risk factors predicting an intolerance to cyclosporine were also investigated.
  
  
  METHODS
  Data were collected on psoriatic patients treated with cyclosporine for at least six months at our Psoriasis Outpatient Unit between January 2005 and September 2010. The primary measure for clinical efficacy was the PASI 75 response. Cyclosporine safety was assessed through the review of both laboratory tests and the adverse events registered during the treatment.
  
  
  RESULTS
  Twenty patients affected with plaque or erythrodermic psoriasis were evaluated. At Week 16, the PASI 75 response was achieved by 85% of patients. Adverse events occurred in eight patients (40%): four experienced an increase in serum creatinine levels to more than 30% of their pre-treatment values and four developed hypertension. Among these patients, five discontinued cyclosporine. Side effects resolved after stopping treatment.
  
  
  CONCLUSIONS
  Our findings suggest that long-term cyclosporine regimen can be justified in severe psoriasis not responsive to other treatments. When cyclosporine administration is required, obesity, pre-treatment controlled hypertension, increased age (>70 years), and metabolic syndrome should be taken into consideration, as a significant correlation with occurrence of cyclosporine-induced side effects has been found.
authors.affiliation: Department of Clinical and Experimental Medicine, Section of Dermatology, University of Ferrara, Ferrara, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Borghi
authors.forename: Monica
authors.initials: M
authors.lastname: Corazza
authors.forename: Lucia
authors.initials: L
authors.lastname: Mantovani
authors.forename: Alberto Maria
authors.initials: AM
authors.lastname: Bertoldi
authors.forename: Silvia
authors.initials: S
authors.lastname: Giari
authors.forename: Annarosa
authors.initials: A
authors.lastname: Virgili
mesh_terms: D000328:Adult; D000368:Aged; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011565:Psoriasis / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine