Cyclosporine for psoriasis

Cyclosporine is a pill, taken twice a day, that suppresses the immune system. It was first developed to stop the body from rejecting a transplanted organ. Its psoriasis benefit was discovered by accident, in transplant patients whose psoriasis improved while taking it. At psoriasis doses, it slows the growth of certain overactive immune cells rather than the skin cells themselves, calming the immune response behind psoriasis.⌁ Evidence⌁ Evidence⌁ Evidence

Cyclosporine treats psoriasis in the skin, typically extensive or disabling disease where faster control is needed. Its current US label states that psoriasis patients should not receive it together with phototherapy (UVB or PUVA), methotrexate, other immune-suppressing medicines, coal tar, or radiation therapy. That is a real difference from most other psoriasis treatments, which are often combined.⌁ Evidence⌁ Evidence

People I have heard from worry most about what happens when a treatment stops working. The current label sets an initial range of 2.5 mg per kilogram of body weight a day, split into two doses. That range is raised gradually to a label maximum of 4.0 mg/kg/day. Patient-education sources report visible improvement as early as two weeks on stronger doses, with three to four months typically needed for the fullest response. AAD reports that 80% to 90% of people treated for 12 to 16 weeks had rapid improvement. Patient-education sources state that cyclosporine is not recommended for longer than one year at a time for psoriasis. Those same sources report that most people relapse within about 14 weeks after stopping.⌁ Evidence⌁ Evidence⌁ Evidence

The current label carries two boxed warnings, its strongest warnings. The first states that only physicians experienced in immunosuppressive therapy should prescribe cyclosporine, because of an increased risk of infection and certain cancers. The second, specific to psoriasis, states that people previously treated with PUVA face a higher skin-cancer risk on cyclosporine. That second warning also states that cyclosporine can cause high blood pressure and kidney damage. Because of that risk, the label requires checking blood pressure and kidney-function blood tests every two weeks for the first three months. After that, checks continue monthly once you are stable. Other reported effects include high cholesterol, excess hair growth, gum swelling, tingling, and stomach upset. Avoid grapefruit and grapefruit juice, which can raise cyclosporine levels, and tell your dermatologist before any vaccination.⌁ Evidence⌁ Evidence⌁ Evidence

I checked one pharmacy-price snapshot. It showed an average cash price of about $146 for 30 capsules of generic cyclosporine modified 100 mg, dropping to about $41 with a common discount coupon. Actual pharmacy prices, insurance coverage, and coupon eligibility vary, and this is one strength and quantity, not a full monthly estimate at a weight-based dose.⌁ Evidence

No reader has sent me a first-hand account of cyclosporine for psoriasis yet. Until someone does, here is what the label and the studies say about living with it.⌁ Evidence

Keep a dated record of each dose and any dose change your dermatologist makes. Note every blood-pressure check and lab result, especially during the every-two-week schedule in the first three months. Track the date you started cyclosporine, since patient-education sources describe a roughly one-year outer limit for this medicine. Add a same-conditions photo around the three-to-four-month mark, then again at any later review your dermatologist sets.⌁ Evidence⌁ Evidence