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Weekend Ciclosporin Maintenance Therapy for Moderate Psoriasis
FR-Terapia de mantenimiento con ciclosporina en pauta de fin de semana para psoriasis moderada
F. Feltes
, E. Macías del Toro, J.L. Ramírez Bellver, C. Bernardez Guerra
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Servicio de Dermatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Feltes, E. Macías del Toro, J.L. Ramírez Bellver, C. Bernardez Guerra" "autores" => array:4 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Feltes" "email" => array:1 [ 0 => "fedefeltes@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Macías del Toro" ] 2 => array:2 [ "nombre" => "J.L." "apellidos" => "Ramírez Bellver" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Bernardez Guerra" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR-Terapia de mantenimiento con ciclosporina en pauta de fin de semana para psoriasis moderada" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is a chronic inflammatory disease of the skin that can affect the joints and is associated with metabolic syndrome. Immunosuppressant agents play a fundamental role in the control of its most severe forms.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Ciclosporin is very effective, but its continual use is associated with renal toxicity, hypertension, and complications secondary to immunosuppression.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The use of ciclosporin microemulsion in a weekend regimen has been proposed as an alternative for long-term treatment in a subgroup of patients.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this article is to draw attention to this therapeutic modality. One of the most important studies was the Psoriasis Relapse Evaluation With Week-End Neoral Treatment (PREWENT), which compared a group of 162 patients treated with a weekend regimen of ciclosporin (5<span class="elsevierStyleHsp" style=""></span>mg/kg/d, 2 days a week) with 81 patients in a placebo group, after induction with ciclosporin in a continuous regimen administered for 8 to 16 weeks until a 75% improvement in the psoriasis area and severity index (PASI) was achieved.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> That prospective, double-blind multicenter study evaluated the recurrence rate at 24 weeks. Compared with placebo, the weekend regimen with ciclosporin produced a significant prolongation (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.023) in the time to recurrence and an increase in the success rate (69.9% vs 46.3%; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.011) in the psoriasis group with a PASI score of 12-19. In the patients with a PASI score<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>12, maintenance therapy was not superior to placebo, as patients in this latter group remained disease free at 6 months after receiving only the continuous induction therapy; in patients with severe psoriasis it was concluded that the weekend regimen was insufficient.</p><p id="par0025" class="elsevierStylePara elsevierViewall">There was no increase in the creatinine levels or blood pressure of the treated patients.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Similar results were obtained in the cohort studied by Fernandes et al.,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> in which induction using a continuous ciclosporin regimen was followed by 20 weeks of therapy in a weekend regimen (10 patients) or a continuous regimen (9 patients). An improvement in the PASI of 75% versus 80%, respectively, at the end of the study demonstrated a similar efficacy of the 2 regimens. The side effects were very much lower in the discontinuous treatment group, although the difference was not statistically significant.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the absence of further trials with greater power, cumulative evidence to date to recommend this therapy is level 2+.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">This regimen is effective for pharmacokinetic reasons and because of the immunological characteristics of the disease. As ciclosporin is a very fat-soluble drug, it accumulates in the skin and is slowly released, thus maintaining its effect. Immunologically, the slow inflammatory response in psoriasis, in contrast to other diseases such as urticaria, is also key to the success of this regimen.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, the weekend regimen of ciclosporin can be useful for maintenance therapy in patients with psoriasis with a basal PASI score of 12 to 19; this regimen is adequately effective and administration is more convenient. The safety profile appears to be more favorable, although further longer-term studies are necessary to confirm this.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "xpalclavsec563111" "titulo" => "Palabras clave" ] 1 => array:2 [ "identificador" => "xpalclavsec563110" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-09-09" "fechaAceptado" => "2014-10-27" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec563110" "palabras" => array:3 [ 0 => "Psoriasis" 1 => "Cyclosporine" 2 => "Week-end therapy" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Feltes F, Macías del Toro E, Ramírez Bellver JL, Bernardez Guerra C. Terapia de mantenimiento con ciclosporina en pauta de fin de semana para psoriasis moderada. Actas Dermosifiliogr. 2015;106:583–584.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ciclosporin in psoriasis clinical practice: An international consensus statement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.E. Griffiths" 1 => "L. Dubertret" 2 => "C.N. Ellis" 3 => "A.Y. Finlay" 4 => "A.F. Finzi" 5 => "V.C. 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Selores" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2012.08.013" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2013" "volumen" => "68" "paginaInicial" => "341" "paginaFinal" => "342" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23317974" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Scottish Intercollegiate Guidelines Network (SIGN). SIGN 50, A guideline developer's handbook. Revised edition 2011 [accessed 28 Sep 2014]. Available at: <a href="http://www.sign.ac.uk/pdf/sign50.pdf">http://www.sign.ac.uk/pdf/sign50.pdf</a>" ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000007/v1_201508271313/S1578219015001754/v1_201508271313/en/main.assets" "Apartado" => array:4 [ "identificador" => "34945" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Resident's Forum" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000007/v1_201508271313/S1578219015001754/v1_201508271313/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001754?idApp=UINPBA000044" ]
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| 2018 Mayo | 0 | 7 | 7 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Febrero | 39 | 5 | 44 |
| 2018 Enero | 41 | 10 | 51 |
| 2017 Diciembre | 39 | 7 | 46 |
| 2017 Noviembre | 27 | 9 | 36 |
| 2017 Octubre | 19 | 9 | 28 |
| 2017 Septiembre | 14 | 16 | 30 |
| 2017 Agosto | 21 | 14 | 35 |
| 2017 Julio | 17 | 14 | 31 |
| 2017 Junio | 26 | 33 | 59 |
| 2017 Mayo | 26 | 33 | 59 |
| 2017 Abril | 21 | 19 | 40 |
| 2017 Marzo | 18 | 37 | 55 |
| 2017 Febrero | 8 | 8 | 16 |
| 2017 Enero | 14 | 8 | 22 |
| 2016 Diciembre | 37 | 13 | 50 |
| 2016 Noviembre | 35 | 16 | 51 |
| 2016 Octubre | 35 | 27 | 62 |
| 2016 Septiembre | 0 | 2 | 2 |
| 2016 Julio | 5 | 0 | 5 |
| 2016 Junio | 14 | 1 | 15 |
| 2016 Mayo | 12 | 0 | 12 |
| 2016 Abril | 7 | 0 | 7 |
| 2016 Marzo | 4 | 0 | 4 |
| 2016 Enero | 0 | 3 | 3 |
| 2015 Noviembre | 0 | 3 | 3 |
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