EFFECT OF LOW-DOSE CYCLOSPORINE ON PLASMA-LIPOPROTEINS AND MARKERS OFCHOLESTASIS IN PATIENTS WITH PSORIASIS

The benefits of using cyclosporin in organ transplantation to prevent graft rejection outweigh its potential disadvantages, but with the use of low-dose cyclosporin in relatively healthy individuals, such as th ose with psoriasis, the risk:benefit ratio is altered. The effects of low-dose cyclosporin (< 5 mg/kg body weight) on liver function and ser um lipids and lipoproteins were examined in 40 normolipidaemic, normot ensive psoriasis patients with normal renal function. After 3 months o f treatment, serum cholesterol and bilirubin concentrations and alkali ne phosphatase activity increased significantly (p = 0.001), and glome rular filtration rate (GFR) declined from 107 to 96 ml/min/1.73 m(2) ( p = 0.05). All these values returned to pretreatment levels 3 months a fter cessation of cyclosporin. In 15 patients in whom lipoproteins wer e isolated by ultracentrifugation, there was an increase in plasma low -density lipoprotein (LDL) cholesterol (p = 0.05), but very-low-densit y lipoprotein cholesterol, high-density lipoprotein (HDL) and HDL(2) a nd HDL(3) cholesterol concentrations did not change. The increases in serum bilirubin, alkaline phosphatase activity and LDL cholesterol, se en in individuals with normal baseline liver and renal function, which reverted to baseline following cessation of cyclosporin, suggest that cyclosporin-induced hypercholesterolaemia may be due to either decrea sed biliary excretion of cholesterol or impaired catabolism of LDL.