R. Bunikowski et al., Low-dose cyclosporin A microemulsion in children with severe atopic dermatitis: Clinical and immunological effects, PEDIAT A IM, 12(4), 2001, pp. 216-223
Cyclosporin A (CsA) is an effective and well-tolerated treatment for severe
childhood atopic dermatitis (AD). By starting at a low dose, the therapeut
ic safety should be further increased. The aim of this study was to evaluat
e low-dose CsA in childhood AD with respect to clinical outcome and modulat
ion of T-cell dysregulation. In an open prospective study, 10 children (age
: 22-106 months) with severe AD (mean objective SCORAD score > 40 on two ba
seline measurements at a minimum interval of 2 weeks) were treated with CsA
solution for 8 weeks. All patients received a starting dose of 2.5 mg/kg/d
ay, which was increased stepwise in non-responders to a maximum of dose of
5 mg/kg/day. Disease activity was monitored using the SCORAD index. The fre
quency of cytokine-producing peripheral blood T lymphocytes was analyzed by
intracellular cytokine staining, and T-cell numbers were measured by fluor
escence-activated cell sorter (FACS) analysis. Twenty healthy age-matched c
hildren were included as controls for the immunological data. Nine of the 1
0 patients had a SCORAD reduction of at least 35%. In seven patients this w
as achieved with low-dose CsA at 2.5 mg/kg/dav (n = 4) and 3.5 mg kg/day (n
= 3). Seven of the nine responders experienced no relapse within the 4-wee
k follow-up period. At baseline the percentage of interleukin-4 (IL-4), IL-
13, and human leucocyte antigen (HLA)-DR-positive CD3(+) cells was higher i
n the patient group than in the controls. After CsA treatment there was a s
ignificant reduction in interferon-gamma (IFN-gamma), IL-2, IL-4, IL-13. an
d HLA-DR-positive CD3(+) cells. Hence, in severe pediatric AD, CsA microemu
lsion. when started at a low dose (2.5 mg/kg/day), improves clinical measur
es of disease, reduces T-lymphocyte cytokine production, and regulates T-ce
ll activation.