MAINTENANCE TREATMENT WITH CYCLOSPORINE IN ATOPIC ECZEMA

We have studied two reducing-dose regimens intended to minimize toxici ty of cyclosporin A (CyA) while maintaining its capacity to control at opic eczema following induction of remission. Twenty-four patients wit h severe chronic atopic eczema were first treated ill a double-blind r andomized placebo-controlled cross-over study of CyA (5 mg/kg/day). Al l 19 who completed the study showed the expected highly significant im provements, compared with placebo, in area involved, erythema, excoria tion, lichenification, itch and requirement for topical steroid. In 17 of the 19 patients, control was re-established with CyA 5 mg/kg/day, and they were then re-randomized to stepwise reduction at 2-week inter vals in either (i) the dose of CyA given daily, or (ii) the frequency with which the 5 mg/kg dose was given. Fifteen patients (seven continu ous reducing, dose, eight intermittent fixed dose) completed the plann ed reduction to either 1 mg/kg/day or 5 mg/kg every fifth day. In both groups the response was sustained despite dose reduction, although co ntrol was less good at a continuous dose of 1 mg/kg. Intermittent trea tment was as good as or better than continuous reducing dosage in this study, and in both groups there was further deterioration after the d rug was stopped. The findings suggest that the dose of CyA required to control atopic eczema is less than that required to achieve remission , and that the therapeutic index can be further improved by alternativ e dosing strategies. This offers a new approach to maintenance treatme nt of eczema and other chronic refractory dermatoses.