Abstract
Background
Cyclosporine, a calcineurin inhibitor of T cells, is an effective treatment option for generalized psoriasis. However, its duration of use is limited to one to two years due to its risk of organ toxicity, while its discontinuation raises concern for relapse. Initiating cyclosporine is often met with reluctance in the absence of a safe, long-term agent with which to transition patients after treatment with cyclosporine. Adalimumab, a tumor necrosis factor inhibitor recently approved for the treatment of psoriasis, may provide a safe alternative for long-term therapy. An experience of using sequential therapy with these two treatments to help prevent relapse in patients transitioning from cyclosporine to adalimumab is described.
Methods
A series of five representative patients is presented. Patients were informed of the off-label nature of concomitant use of cyclosporine and adalimumab for the treatment of psoriasis.
Results
Five patients with severe generalized psoriasis, ages 17, 21, 22, 31, and 41, were treated with cyclosporine for one to two years prior to beginning treatment with adalimumab. Cyclosporine was tapered over a period of 6, 12, 12, 8 and 11 weeks respectively and eventually discontinued. There was no decrease in Psoriasis Area and Severity Index (PASI) scores from the time of initiating adalimumab to discontinuation of cyclosporine. Serum labs and blood pressure readings remained normal for all five patients during this period and no adverse events were noted.
Conclusion
Patients may be smoothly transitioned from cyclosporine to adalimumab through sequential therapy to minimize risk of recurrence of psoriasis. The short duration of three months or less in young healthy individuals may allow safe concomitant use of these two drugs. Whether sequential therapy of cyclosporine and long-term treatment with adalimumab will be successful and safe must be validated by large controlled studies.
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