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Inflammatory Bowel Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Cyclosporin should preferably not be initiated during pregnancy [53, 54]. It has not been found to be teratogenic in humans [65–67]. However, it is associated with SGA, preterm birth, hypertension and seizures [67, 68]. Breastfeeding is not recommended because of potential neonatal nephrotoxicity and immunosuppression [69].
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The short-term adverse effects of ciclosporin include hypertrichosis, gingival hyperplasia, hypertension, tremor and a rise in plasma creatinine mediated by glomerular vasoconstriction. The major factor limiting the prolonged use of ciclosporin is concern about potential chronic nephrotoxicity, which has been reported in SSNS patients taking ciclosporin continuously for more than two years [23]. Plasma creatinine concentration does not provide any indication of structural damage until a relatively advanced stage has been reached. For this reason, it is widely accepted practice to perform a renal biopsy after 1 8 - 2 4 months of therapy. Ciclosporin may be continued beyond two years in those patients with no histological evidence of chronic nephrotoxicity.
Psoriasis and lichen planus
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
Ciclosporin is an immunosuppressive agent used in organ transplantation. It appears to work by inhibiting the synthesis of cytokines by T-lymphocytes. It is also dramatically effective in psoriasis when given in doses of 3–5 mg/kg per day. Its toxic side effects include severe renal damage, hypertension, hyperlipidaemia and hypertrichosis. Its place in the treatment of disabling and severe psoriasis is assured, but great care and constant monitoring are required.
Spesolimab, an interleukin-36 receptor monoclonal antibody, for the treatment of generalized pustular psoriasis
Published in Expert Review of Clinical Immunology, 2023
Patients with a flare of GPP need urgent access to clinicians experienced in the diagnosis and management of acute inflammatory skin disease for a comprehensive assessment of the extent and severity of the disease, co-morbidities and complications. When extensive or associated with significant systemic involvement, treatment as a hospital inpatient is often needed for symptom control and supportive care, including emollients and often topical corticosteroids. Unless the flare is mild or of short duration, systemic treatment is also usually required. As the evidence base for the efficacy and safety of therapy in GPP is limited to case reports and small open-label studies, treatments that have a license for severe plaque psoriasis have often been used, including acitretin, methotrexate, ciclosporin and targeted biologic treatments [25]. The use of the systemic retinoid acitretin (and the closely-related etretinate) has been reported in small retrospective case series in GPP and subsequently widely adopted globally [7,26]. Although not quickly or reliably effective, the fact that it is not immuno-suppressive, as most other available options are, is useful in a situation in which systemic infection can be difficult to exclude. Ciclosporin is generally more effective and quicker to act, making it a useful choice when the speed of onset is important, but it is not ideal for maintenance treatment because of the risk of cumulative toxicity.
Mapping knowledge structures and theme trends of atopic dermatitis: a co-word biclustering and quantitative analysis of the publication between 2015 and 2019
Published in Journal of Dermatological Treatment, 2022
Zhenzhen Mu, Yue Zhang, Lin Li, Xiuping Han
Cluster 4 relates to the drug therapy of AD, mainly including biologics and small molecule agents, and plant extracts agents. For a long time, AD treatment evolved rather slowly, from the use of topical emollients during the 1930s to the use of topical steroids in the 1960s and 2000 to the application of calcineurin inhibitors (18). Ciclosporin, as the main systemic treatment for severe AD in routine, is a calcineurin inhibitor that can improve the disease quickly (19). However, soon after treatment withdrawal, relapse is frequently observed. Moreover, ciclosporin has very significant side effects including nephrotoxicity and hypertension. azathioprine and methotrexate and other immunosuppressive agents have a comparatively better safety profile, however a limited efficacy for extreme AD as well. Myelosuppression can also be caused by azathioprine and has an increased risk of causing lymphoma, nonmelanoma, and infections (19). Thus, those drugs cannot be used for several years and novel agents with improved long-term safety attributes need to be developed. New biological agents, such as anti-interleukin (IL) 4/IL-13 antibody, are available only now in 2016 after a considerably long wait (18). Novel targeted biologics such as anti-JAK antibody and anti-IL-22 antibody have emerged recently after clinical trials, which would furnish a rather extensive range of therapeutic choices. Chinese herbal medicine or plant extracts, such as Jageum-Jung and Hovenia Dulcis, complement each other with modern medicine and have also received great attention for treating atopic dermatitis in recent years (20,21).
Current and emerging pharmacotherapy for chronic spontaneous Urticaria: a focus on non-biological therapeutics
Published in Expert Opinion on Pharmacotherapy, 2021
Kam Lun Hon, Joyce T. S. Li, Alexander K.C. Leung, Vivian W. Y. Lee
If symptoms are not adequately controlled within six months after starting omalizumab, or if symptoms are intolerable, ciclosporin A could be added on to the second-generation H1-antihistamine according to EAACI/GA2LEN/EDF/WAO guideline suggestion [5]. The AAAAI/ACAAI practice parameters recommend ciclosporin A to be used as an alternative agent in refractory CU patients after balancing the potential benefit and potential harm [42]. Ciclosporin A is a calcineurin inhibitor that effects mast cell mediators release. When used in combination with second-generation H1-antihistamine, ciclosporin A has shown efficacy in both open-label and placebo-controlled trials [55–58]. Side effects of ciclosporin A include hypertension, renal toxicity, and gum hypertrophy. The use of ciclosporin A is off-label for CSU as adjuvant therapy in patients with severe CSU disease refractory to antihistamines and omalizumab [5].