Introduction to dermatological treatment
Richard Ashton, Barbara Leppard in Differential Diagnosis in Dermatology, 2021
Ciclosporin is an immunosuppressive drug which is useful in the treatment of severe atopic eczema and psoriasis. The starting dose is 3–5 mg/kg/day. Its effect is rapid (within 2 weeks). Once the disease is under control the dose can be reduced and replaced by a safer agent long term as its continuous use beyond 1 to 2 years is associated with oncogenesis. It is not teratogenic so can be useful in severe skin disease in pregnancy. The bioavailability and pharmacodynamics of different ciclosporin formulations varies significantly and it is advised to stick to a single available agent from a single manufacturer in a prescribing region as loss of efficacy as well as toxicity has been described on inadvertent switching of brands.
Respiratory, endocrine, cardiac, and renal topics
Evelyne Jacqz-Aigrain, Imti Choonara in Paediatric Clinical Pharmacology, 2021
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
Ronald Marks, Richard Motley in 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.
Systemic medications used in treatment of common dermatological conditions: safety profile with respect to pregnancy, breast feeding and content in seminal fluid
Published in Journal of Dermatological Treatment, 2019
Sarah Madeline Brown, Khadija Aljefri, Rachel Waas, Philip Hampton
Ciclosporin is a calcineurin inhibitor that suppresses interleukin-2 production by T-helper lymphocytes resulting in a reversible impairment of both T-cell dependent humoral immunity and also in cell-mediated immunity (48). Ciclosporin is very lipid soluble, it is therefore quickly metabolized and can be extensively distributed in the body (49). It crosses the placenta, blood concentrations in the fetus are 30–64% that of the maternal circulation. Ciclosporin is not an animal teratogen and has not been shown to be teratogenic in human case reports (50). In animal studies, ciclosporin has only found to be toxic to the fetus at maternally toxic doses with toxic effects including reduced birth weight and increased pre- and post-natal mortality (50). There have been several studies of ciclosporin use in pregnancy, a retrospective study of 629 pregnancies where ciclosporin was administered ranging from the 6th week of pregnancy to the whole gestation at doses of between 1.4 and 14 mg/kg/day showed a fetal loss and malformation rate which was similar to that of the background population – 9.7% and 3%, respectively. It did however show an association with low-birth weight in 44.3% and prematurity in 44.5%. In another review by Bar Oz et al. of 15 studies ciclosporin did not appear to show a teratogenic effect, however it was associated with prematurity (51). The patients on ciclosporin generally have a complicated health status and the low birth rate could be related to the underlying maternal disease process (50).
Eltrombopag in the management of aplastic anaemia: real-world experience in a non-trial setting
Published in Hematology, 2018
Yu-Yan Hwang, Harinder Gill, Thomas S.Y. Chan, Garret M.K. Leung, Carol Y.M. Cheung, Yok-Lam Kwong
Ten patients received eltrombopag as the initial therapy (Table 1). In four patients (cases 2, 3, 5, 6), concomitant ATG (horse, N = 2; rabbit, N = 1; rabbit then horse ATG, N = 1) and ciclosporin were administered. In five patients, concomitant ciclosporin was administered. ATG was not used because of advanced age (case 4), patient’s choice (case 8, 9, 10), and original mis-diagnosis as immune thrombocytopenia (case 7, which led to the previous administration of four doses of the anti-CD20 antibody obinutuzumab). In one patient (case 1), eltrombopag was the only drug used. This patient had severe rheumatoid arthritis treated with adalimumab and poorly controlled type I diabetes mellitus with neuropathy; so that further immunosuppression with ATG and ciclosporin was considered hazardous. The maximum dose of eltrombopag ranged from 50 to 300 mg/day (median: 150 mg/day).
Nanomedicine for immunosuppressive therapy: achievements in pre-clinical and clinical research
Published in Expert Opinion on Drug Delivery, 2018
Hanan Al-Lawati, Hamidreza Montazeri Aliabadi, Behzad Sharif Makhmalzadeh, Afsaneh Lavasanifar
Uncovering of the immunosuppressive activity of cyclosporine A (cyclosporine) isolated from Tolypocladium inflatum gams in 1971 have been among the greatest discoveries in the treatment of organ transplant rejection [40]. This highly lipophilic cyclic undecapeptide selectively targets the proliferation of helper T-cells, but not the suppressor T-cells [41]. Cyclosporine is indicated for the prevention of rejection following transplantation of heart, lung, and kidney; treatment of graft versus host disease with bone marrow transplant; and treatment of various autoimmune conditions such as RA, nephrotic syndrome, and psoriasis [42]. It is available for intravenous (IV) infusion at a dose of 2–4 mg/kg/day. Its oral administration as soft gelatin capsules or solution is more commonly used, however. The original cyclosporine product, Sandimmune, is an oil-in-water emulsion. A newer microemulsion formulation of cyclosporine, Neoral, with improved bioavailability is also approved for use [43]. An ophthalmic emulsion of cyclosporine, Restasis, is also approved for the treatment of inflammation in the dry eye syndrome.
Related Knowledge Centers
- Immunosuppressive Drug
- Oral Administration
- Intravenous Therapy
- Rheumatoid Arthritis
- Psoriasis
- Crohn's Disease
- Nephrotic Syndrome
- Dermatitis
- Organ Transplantation
- Transplant Rejection