A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life

Background: Cyclosporine has shown to be effective in severe atopic dermati tis. Little has been reported on the new microemulsion form (Sandimmune, Ne oral) in the treatment of this disease. Also, it has not been investigated whether a body-weight-independent dosing regimen of cyclosporine is appropr iate for the treatment of atopic dermatitis. Objective: The goal of this study was to investigate a body-weight-independ ent dosing regimen of cyclosporine microemulsion in severe atopic dermatiti s by comparing high and low starting doses of treatment. Methods: A total of 106 adults with severe atopic dermatitis were enrolled in this double-blind study and randomized to receive a starting dose of eit her 150 mg (low) or 300 mg (high) of cyclosporine microemulsion daily. Afte r 2 weeks the dose could be reduced by 50% if the clinical symptom score wa s reduced by 50% or more. After 8 weeks the responders entered a 4-week fol low-up phase and were randomized to either stop treatment or to continue on their last effective dose every second day. Results: After 2 weeks of treatment the total symptom score decreased from 59.0 to 39.3 with 150 mg and from 60.7 to 33.2 with 300 mg cyclosporine (P< .05). Until week 8 there was a further decrease in the clinical symptom sco re to 30.8 with low-dose therapy and 25.5 with high-dose therapy Similar po sitive effects could be observed in assessments of affected body surface ar ea, itching, sleep loss, and quality of life. At week 2, there was an incre ase of 0.6% in serum creatinine in patients receiving 150 mg, and 5.8% in t he 300 mg group (P<.01). At week 8, the effect on serum creatinine was simi lar, with a 1.1% rise in the low dose group and a 6.0% increase in the high dose group. Body weight had no influence on efficacy or tolerability in th is study. Conclusion: Body-weight-independent dosing with cyclosporine seems to be fe asible in the short-term treatment of severe atopic dermatitis. Although th e starting dose of 300 mg/day is more effective than 150 mg/day, the 150 mg dose would be preferable for the initiation of therapy because of its exce llent renal tolerability.