EFFICACY OF CYCLOSPORINE-A (CYA) IN PSORIASIS - AN OVERVIEW OF DOSE-RESPONSE, INDICATIONS, CONTRAINDICATIONS AND SIDE-EFFECTS

Since 1985, the efficacy of cyclosporin A (CyA) in severe psoriasis has been evaluated in a number of open and controlled studies, all of which have clearly established CyA as an effective antipsoriatic agent. The efficacy of CyA has also provided new insights into the pathophysiology of psoriasis. The effects of CyA treatment can be seen within weeks; they are dose-dependent and quickly reversible on stopping treatment. Hypertension and nephrotoxicity remain the greatest concerns associated with long-term use. In general, the incidence of hypertension is approximately 10%. A dosage of approximately 2.5-5 mg/kg/day of CyA induces a slight, but significant, dose dependent increase in serum creatinine. Studies of pre- and post-treatment renal biopsies have also disclosed slight, but significant, increases in interstitial fibrous tissue which are negatively correlated to creatinine clearance. This review assesses the current knowledge of the prospects of CyA in the treatment of psoriasis with respect to dose/response, indications, contraindications and side-effects.