Update on Systemic Therapies for Atopic Dermatitis
Update on Systemic Therapies for Atopic Dermatitis
Cyclosporine (CSA) and mycophenolate mofetil, the prodrug of mycophenolic acid, are immunosuppressants approved to prevent transplant rejection. In light of the potential for nephrotoxicity and hypertension with chronic CSA therapy, it is challenging to determine when and in which atopic dermatitis patients this medication should be considered. Fifty-five adult atopic dermatitis patients who were unresponsive to topical therapies were treated for 6 weeks with high-dose CSA (5 mg/kg/day divided into two doses) as an acute management strategy. This was followed by randomization to receive maintenance treatment with either CSA 3 mg/kg/day or enteric-coated mycophenolate sodium (1440 mg/day) for 30 weeks followed by a 12-week follow-up period. During the run-in phase, all patients experienced a significant improvement in SCORAD (SCORing Atopic Dermatitis) and serum thymus and activation-regulated chemokine (TARC) levels. Although initially patients randomized to CSA maintenance had better control of their atopic dermatitis, by 10 weeks the average SCORAD values were comparable. In the follow-up phase, the mycophenolate-treated arm maintained greater disease control than those who had received CSA as a maintenance treatment. Although the potential for nephrotoxicity and hypertension relegates CSA to a third-line choice as an atopic dermatitis maintenance strategy, this study demonstrated the value of using high-dose CSA to achieve rapid initial control of atopic dermatitis prior to switching to an arguably safer longer-term medication (i.e. mycophenolate). This is an interesting study that suggests a treatment approach whereby high-dose CSA is used to achieve rapid, short-term control of atopic dermatitis and maintenance of this benefit is achieved with safer immunosuppressants. This approach avoids the adverse effects, which commonly arise with chronic CSA use.
Cyclosporine, Mycophenolate Mofetil, and Mycophenolic Acid
Cyclosporine (CSA) and mycophenolate mofetil, the prodrug of mycophenolic acid, are immunosuppressants approved to prevent transplant rejection. In light of the potential for nephrotoxicity and hypertension with chronic CSA therapy, it is challenging to determine when and in which atopic dermatitis patients this medication should be considered. Fifty-five adult atopic dermatitis patients who were unresponsive to topical therapies were treated for 6 weeks with high-dose CSA (5 mg/kg/day divided into two doses) as an acute management strategy. This was followed by randomization to receive maintenance treatment with either CSA 3 mg/kg/day or enteric-coated mycophenolate sodium (1440 mg/day) for 30 weeks followed by a 12-week follow-up period. During the run-in phase, all patients experienced a significant improvement in SCORAD (SCORing Atopic Dermatitis) and serum thymus and activation-regulated chemokine (TARC) levels. Although initially patients randomized to CSA maintenance had better control of their atopic dermatitis, by 10 weeks the average SCORAD values were comparable. In the follow-up phase, the mycophenolate-treated arm maintained greater disease control than those who had received CSA as a maintenance treatment. Although the potential for nephrotoxicity and hypertension relegates CSA to a third-line choice as an atopic dermatitis maintenance strategy, this study demonstrated the value of using high-dose CSA to achieve rapid initial control of atopic dermatitis prior to switching to an arguably safer longer-term medication (i.e. mycophenolate). This is an interesting study that suggests a treatment approach whereby high-dose CSA is used to achieve rapid, short-term control of atopic dermatitis and maintenance of this benefit is achieved with safer immunosuppressants. This approach avoids the adverse effects, which commonly arise with chronic CSA use.