Efficacy of Novel Topical Liposomal Formulation of Cyclosporine in Mild to Moderate Stable Plaque Psoriasis: A Randomized Clinical Trial.
Attempts to use topical cyclosporine in treatment of psoriasis have failed because of unfavorable physicochemical properties and inappropriate formulation design of the conventional dosage forms.



To evaluate the efficacy of topical cyclosporine using liposomal nanocarriers (lipogel) in limited chronic plaque psoriasis.



A single-center randomized clinical trial was conducted using a 3-arm parallel group, double-blind, vehicle and active comparator design and included 38 patients with chronic plaque psoriasis measuring less than or equal to 100 cm2 performed in a tertiary care hospital.



In the first arm, a total of 24 patients were randomized to receive either cyclosporine lipogel, 2.0% weight by weight (w/w), or placebo lipogel. In the second arm, 7 patients were randomized to receive cyclosporine lipogel, 2.0%, or conventional cyclosporine cream, 2.0% w/w. The third arm comprised 7 patients randomized with cyclosporine lipogel, 2.0% or standard clobetasol propionate cream, 0.05% w/w. Patients were examined twice weekly for 14 weeks, or until total lesional clearance was observed, whichever was earlier.



The primary outcome measure was the dermatological sum score (DSS) assessing erythema, scaling, and plaque elevation on a 4-point scale (0, absent; 1, minimal; 2, moderate; 3, severe).



In 38 patients (23 men and 15 women with a mean [SD] age range from 35 [8] to 40 [13] years), a 19% decrease in DSS score from a mean (SD) of 8.45 (0.67) to 6.82 (0.77) compared with baseline was observed after 2 weeks of treatment with cyclosporine lipogel, 2.0% w/w (P < .001; 95% CI, 13.77-24.51) in 59% of psoriasis lesional sites. At the end of the eighth week, a significant reduction (approximately 83%) in DSS was seen in all sites treated with cyclosporine lipogel, (P < .001; 95% CI, 77.48-88.22). At the end of the study period, complete clearance (ie, DSS = 0) was observed in 16 (41%) psoriasis lesional sites treated with cyclosporine lipogel, 85.7% of sites treated with clobetasol propionate cream, and none of the sites treated with conventional cyclosporine cream or placebo gel.



Topical liposomal formulation of cyclosporine, 2.0% w/w, is effective in treatment of limited chronic plaque psoriasis with a satisfactory safety profile. Future clinical trials should assess liposomal cyclosporine in larger study populations.



Clinical Trials Registry-India Identifier: CTRI/2011/12/002307.
University Institute of Pharmaceutical Sciences-UGC Center of Advanced Studies, Panjab University, Chandigarh, India.
Rajiv
R
Kumar
Department of Dermatology, and Venereology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Sunil
S
Dogra
University Institute of Pharmaceutical Sciences-UGC Center of Advanced Studies, Panjab University, Chandigarh, India.
Basant
B
Amarji
University Institute of Pharmaceutical Sciences-UGC Center of Advanced Studies, Panjab University, Chandigarh, India.
Bhupinder
B
Singh
Suresh
S
Kumar
Department of Statistics, Panjab University, Chandigarh, India.
Sharma
Department of Dermatology, and Venereology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Keshavamurthy
K
Vinay
Department of Dermatology, and Venereology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Rahul
R
Mahajan
University Institute of Pharmaceutical Sciences-UGC Center of Advanced Studies, Panjab University, Chandigarh, India.
O P
OP
Katare
D000287:Administration, Topical; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002990:Clobetasol / Q000008:administration & dosage; D016572:Cyclosporine / Q000008:administration & dosage* / Q000097:blood; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005782:Gels; D006801:Humans; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D049329:Nanostructures; D011565:Psoriasis / Q000188:drug therapy*; D012720:Severity of Illness Index; D063465:Skin Cream / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents; D005782:Gels; D008081:Liposomes; D016572:Cyclosporine; D002990:Clobetasol