Short-term, Low Dose Oral Cyclosporine Treatment in Patients with Psoriasis: An Association between Response to Cyclosporine Therapy and Systemic Inflammation Using High Sensitivity C-reactive Protein

Jeong, Taek Jo; Shin, Min Kyung; Kim, Nack In

Abstract

BACKGROUND
Cyclosporine is an immunosuppressant that acts on T-cells and cytokines. Although the efficacy of systemic cyclosporine in the treatment of psoriasis has been established, the relationship between response to cyclosporine and systemic inflammation using the high sensitivity C-reactive protein (hs-CRP) immunoassay is still unclear.
OBJECTIVE
The aim of this study is to investigate whether systemic inflammation with clinical and laboratory findings indicate a response after 8 weeks of oral 3 mg/kg cyclosporine therapy in patients with psoriasis.
METHODS
Thirty-five patients with psoriasis were treated with oral cyclosporine for 8 weeks. The clinical response to oral cyclosporine was determined using the PASI score. The correlation between hs-CRP and the treatment response to cyclosporine was analyzed. Also, descriptive characteristics of psoriatic patients with psoriatic arthritis, metabolic syndrome, and high BMI (BMI> or =25) were investigated.
RESULTS
Hs-CRP levels and PASI scores were significantly reduced after 8 weeks of oral cyclosporine treatment. Eight patients showed excellent response, fifteen a good response, and twelve a moderate response. The baseline hs-CRP levels in excellent and good response groups (1.35+/-0.59 mg/L and 1.32+/-0.86 mg/L, respectively) to oral cyclosporine were significantly higher than the moderate response group (0.51+/-0.20 mg/L, p=0.004). Psoriatic patients with psoriatic arthritis, metabolic syndrome, and high BMI demonstrated higher levels of baseline hs-CRP. Patients with psoriatic arthritis and metabolic syndrome showed greater response to cyclosporine treatment.
CONCLUSION
Patients with greater inflammatory burden, as demonstrated by elevated baseline hs-CRP, have better treatment responses to cyclosporine compared to patients with lesser inflammation.