The efficacy and side-effects of
cyclosporin in
psoriasis, namely
hypertension and renal dysfunction, are dose-related. An initial dose of 3 mg/kg per day has a better risk/benefit ratio than 5 mg/kg per day. Maximum efficacy is usually reached after 2-3 months, and effects of the
drug remain even
after treatment stops. We therefore suggest that periodic short-term use of
cyclosporin in order to combine persisting
therapeutic effect with safety. Psoriatic
erythroderma and
arthropathy also respond rapidly to oral
cyclosporin. Once patients have been successfully treated, the
drug should be discontinued. Treatment must not exceed 6 months, but in the case of relapse a new cycle of the previously effective and tolerated dose can be given. The concomitant use of other
therapies has been assessed in an attempt to reduce the dose of
cyclosporin. There are no significant
cyclosporin-sparing effects when
etretinate or UVB are used adjunctively, and currently no convincing data on the risk of combining low-dose
cyclosporin with immunosuppressive therapy (including
methotrexate, UVB, and PUVA) in dermatological indications. The addition of topical
corticosteroids or
calcipotriol leads to more rapid clearing of
psoriasis plaques, although relapse rates remain unchanged. Individualized short-course
cyclosporin therapy is useful in controlling acute
psoriasis flares and/or inducing remission; less potent agents can then be used for maintenance
therapy. Short courses of low-dose
cyclosporin may almost completely eliminate the risks of renal dysfunction from this
drug.