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Weekend cyclosporine A therapy comparable to daily treatment for psoriasis

A 2-day weekend regimen and a continuous regimen of cyclosporine A for 20 weeks showed comparable results as treatment for plaque psoriasis, according to data from a recent study.

In a 32-week, prospective observational cohort study, researchers in Portugal evaluated 21 patients (mean age, 44.3 years; 52.4% men) with plaque psoriasis (mean Psoriasis Area and Severity Index [PASI] score of 15.0). Nine patients had associated comorbidities. Monitoring occurred at weeks 6, 12, 22 and 32 while patients received cyclosporine A (CsA) therapy.

An induction treatment of 4 mg/kg/day CsA was given for 12 weeks to all patients without contraindications. No significant differences existed between groups in mean PASI score (which decreased to 2.9; P=.81), gender, age, BMI or comorbidities after induction. Nineteen patients (90%) achieved PASI 75 and were randomly assigned either 5 mg/kg/day CsA for 2 consecutive weekend days (n=10) or continuous daily CsA treatment at 2 mg/kg to 3 mg/kg (n=9) for 20 additional weeks. At the end of the study, PASI 75 was achieved by 80% of the weekend therapy patients and 75% of the continuous treatment patients.

Four continuous therapy patients and one in the weekend group experienced adverse effects, including hypertriglyceridemia, infection and hirsutism. Continuous therapy patients had a greater mean daily dose of CsA than weekend patients (2.6 mg/kg/day vs. 1.4 mg/kg/day).

“The twice weekly dosing schedule was more convenient for patients,” the researchers reported. “The effectiveness of weekend CsA therapy might be explained by its rapid effect on inflammatory and endothelial cells, as evidenced by decreased skin T lymphocytes within 3 days. In psoriasis, the inflammatory recovery time is very slow in comparison with other dermatoses. Therefore, it seems reasonable to discontinue treatment for 3 to 5 days.

“Despite the limited number of patients, our study suggests that weekend CsA maintenance therapy for psoriasis seems to be a valid option.”