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Oral cyclosporine observed most effective in infection-driven atopic dermatitis

ORLANDO, Fla. — Oral cyclosporine is most effective in severe infections that cause atopic dermatitis once infection has been treated with appropriate antibiotics, according to data presented at the American Academy of Allergy, Asthma and Immunology 2012 Annual Meeting.

To determine how effective oral cyclosporine would be in children for the treatment of atopic dermatitis (AD) unresponsive to topical corticosteroids and calcineurin inhibitors, researchers analyzed clinical features and outcomes of children receiving oral cyclosporine for severe AD.

“This study revolves around the use cyclosporin as treatment for children with severe eczema,” Peter D. Arkwright, FRCPCH, DPhil, told Infectious Diseases in Children. “These include cases in which children are absolutely covered in eczema — they are very red, they are very itchy, to the point that they are not sleeping. It’s impacting not only their lives but also their family’s lives.”

Thirty-five children receiving 5 mg daily oral cyclosporine at a single tertiary pediatric eczema clinic were reviewed retrospectively. All of the children in the review had severe generalized AD and disrupted sleep due to unremitting pruritis — 33 children received regular moderate-potent topic corticosteroids.

“Cyclosporine is a way to get the eczema under control, but you also need to get the infection under control as well because often the flare is secondary to infection,” Arkwright said. “With cyclosporine treatment, some patients improve with cyclosporin and some patients don’t. Our study examined which patients are most likely to improve with cyclosporin and what we have observed is that those patients with a secondary infection are much more likely to improve with this treatment.”

The median length of treatment with cyclosporine was 19 weeks and plasma trough level was 47 mcg/L; 16 (46%) patients had a marked dissipation of their eczema. None of the reviewed patients reported abnormalities in renal function checked on a monthly basis. One patient developed eczema herpeticum.

The only aspect that determined outcome was whether the AD was infection-driven based on clinical features (10% of patients without secondary infection improved vs. 63% with secondary infection; P <.001).

“In the past, cyclosporine would be used for short periods of time up to 6 weeks, and then discontinued,” Arkwright said. “However, if cyclosporine is stopped abruptly, we found that patients were more likely to receive a bad flare. Instead, we have been weaning slowly over a number of months, and this approach seems to prevent flares, and allow us to get them under control and keep them under control.” — by Bob Stott

Reference: Arkwright PD. #145. Factors Determining The Effectiveness Of Oral Cyclosporine In Children With Severe Atopic Dermatitis (AD). Presented at: the 2012 AAAAI Annual Meeting; March 2-6, 2012; Orlando, Fla.

Disclosures: Infectious Diseases in Children was unable to confirm relevant financial disclosures at the time of publication.