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Ciclosporin in psoriasis clinical practice: an international consensus statement

Authors

  • C.E.M. Griffiths,

    1. Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
      *Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France
      †Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
      ‡Department of Dermatology, University of Wales College of Medicine, Cardiff, UK
      §Department of Dermatology, University of Milan, Milan, Italy
      ¶Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
      **Clinical Pharmacology, Barts and The London, University of London, UK
      ††Department of Dermatology, University of Athens, A.Sygros Hospital, Athens, Greece
      ‡‡Department of Nephrology and Transplantation, Medizinische Klinik III, Zentralkrankenhaus, Bremen, Germany
      §§Department of Dermatology, Ghent University Hospital, Gent, Belgium
      ¶¶Department of Dermatology, Jichi Medical School, Tochigi, Japan
      ***Clinical Research Department, Novartis Pharma AG, Basel, Switzerland, and Department of Dermatology, Mulhouse General Hospital, Mulhouse, France
      †††Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
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  • L. Dubertret,

    1. Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
      *Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France
      †Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
      ‡Department of Dermatology, University of Wales College of Medicine, Cardiff, UK
      §Department of Dermatology, University of Milan, Milan, Italy
      ¶Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
      **Clinical Pharmacology, Barts and The London, University of London, UK
      ††Department of Dermatology, University of Athens, A.Sygros Hospital, Athens, Greece
      ‡‡Department of Nephrology and Transplantation, Medizinische Klinik III, Zentralkrankenhaus, Bremen, Germany
      §§Department of Dermatology, Ghent University Hospital, Gent, Belgium
      ¶¶Department of Dermatology, Jichi Medical School, Tochigi, Japan
      ***Clinical Research Department, Novartis Pharma AG, Basel, Switzerland, and Department of Dermatology, Mulhouse General Hospital, Mulhouse, France
      †††Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
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  • C.N. Ellis,

    1. Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
      *Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France
      †Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
      ‡Department of Dermatology, University of Wales College of Medicine, Cardiff, UK
      §Department of Dermatology, University of Milan, Milan, Italy
      ¶Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
      **Clinical Pharmacology, Barts and The London, University of London, UK
      ††Department of Dermatology, University of Athens, A.Sygros Hospital, Athens, Greece
      ‡‡Department of Nephrology and Transplantation, Medizinische Klinik III, Zentralkrankenhaus, Bremen, Germany
      §§Department of Dermatology, Ghent University Hospital, Gent, Belgium
      ¶¶Department of Dermatology, Jichi Medical School, Tochigi, Japan
      ***Clinical Research Department, Novartis Pharma AG, Basel, Switzerland, and Department of Dermatology, Mulhouse General Hospital, Mulhouse, France
      †††Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
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  • A.Y. Finlay,

    1. Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
      *Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France
      †Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
      ‡Department of Dermatology, University of Wales College of Medicine, Cardiff, UK
      §Department of Dermatology, University of Milan, Milan, Italy
      ¶Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
      **Clinical Pharmacology, Barts and The London, University of London, UK
      ††Department of Dermatology, University of Athens, A.Sygros Hospital, Athens, Greece
      ‡‡Department of Nephrology and Transplantation, Medizinische Klinik III, Zentralkrankenhaus, Bremen, Germany
      §§Department of Dermatology, Ghent University Hospital, Gent, Belgium
      ¶¶Department of Dermatology, Jichi Medical School, Tochigi, Japan
      ***Clinical Research Department, Novartis Pharma AG, Basel, Switzerland, and Department of Dermatology, Mulhouse General Hospital, Mulhouse, France
      †††Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
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  • A.F. Finzi,

    1. Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
      *Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France
      †Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
      ‡Department of Dermatology, University of Wales College of Medicine, Cardiff, UK
      §Department of Dermatology, University of Milan, Milan, Italy
      ¶Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
      **Clinical Pharmacology, Barts and The London, University of London, UK
      ††Department of Dermatology, University of Athens, A.Sygros Hospital, Athens, Greece
      ‡‡Department of Nephrology and Transplantation, Medizinische Klinik III, Zentralkrankenhaus, Bremen, Germany
      §§Department of Dermatology, Ghent University Hospital, Gent, Belgium
      ¶¶Department of Dermatology, Jichi Medical School, Tochigi, Japan
      ***Clinical Research Department, Novartis Pharma AG, Basel, Switzerland, and Department of Dermatology, Mulhouse General Hospital, Mulhouse, France
      †††Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
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  • V.C. Ho,

    1. Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
      *Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France
      †Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
      ‡Department of Dermatology, University of Wales College of Medicine, Cardiff, UK
      §Department of Dermatology, University of Milan, Milan, Italy
      ¶Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
      **Clinical Pharmacology, Barts and The London, University of London, UK
      ††Department of Dermatology, University of Athens, A.Sygros Hospital, Athens, Greece
      ‡‡Department of Nephrology and Transplantation, Medizinische Klinik III, Zentralkrankenhaus, Bremen, Germany
      §§Department of Dermatology, Ghent University Hospital, Gent, Belgium
      ¶¶Department of Dermatology, Jichi Medical School, Tochigi, Japan
      ***Clinical Research Department, Novartis Pharma AG, Basel, Switzerland, and Department of Dermatology, Mulhouse General Hospital, Mulhouse, France
      †††Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
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  • A. Johnston,

    1. Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
      *Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France
      †Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
      ‡Department of Dermatology, University of Wales College of Medicine, Cardiff, UK
      §Department of Dermatology, University of Milan, Milan, Italy
      ¶Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
      **Clinical Pharmacology, Barts and The London, University of London, UK
      ††Department of Dermatology, University of Athens, A.Sygros Hospital, Athens, Greece
      ‡‡Department of Nephrology and Transplantation, Medizinische Klinik III, Zentralkrankenhaus, Bremen, Germany
      §§Department of Dermatology, Ghent University Hospital, Gent, Belgium
      ¶¶Department of Dermatology, Jichi Medical School, Tochigi, Japan
      ***Clinical Research Department, Novartis Pharma AG, Basel, Switzerland, and Department of Dermatology, Mulhouse General Hospital, Mulhouse, France
      †††Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
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  • A. Katsambas,

    1. Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
      *Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France
      †Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
      ‡Department of Dermatology, University of Wales College of Medicine, Cardiff, UK
      §Department of Dermatology, University of Milan, Milan, Italy
      ¶Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
      **Clinical Pharmacology, Barts and The London, University of London, UK
      ††Department of Dermatology, University of Athens, A.Sygros Hospital, Athens, Greece
      ‡‡Department of Nephrology and Transplantation, Medizinische Klinik III, Zentralkrankenhaus, Bremen, Germany
      §§Department of Dermatology, Ghent University Hospital, Gent, Belgium
      ¶¶Department of Dermatology, Jichi Medical School, Tochigi, Japan
      ***Clinical Research Department, Novartis Pharma AG, Basel, Switzerland, and Department of Dermatology, Mulhouse General Hospital, Mulhouse, France
      †††Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
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  • A-E. Lison,

    1. Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
      *Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France
      †Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
      ‡Department of Dermatology, University of Wales College of Medicine, Cardiff, UK
      §Department of Dermatology, University of Milan, Milan, Italy
      ¶Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
      **Clinical Pharmacology, Barts and The London, University of London, UK
      ††Department of Dermatology, University of Athens, A.Sygros Hospital, Athens, Greece
      ‡‡Department of Nephrology and Transplantation, Medizinische Klinik III, Zentralkrankenhaus, Bremen, Germany
      §§Department of Dermatology, Ghent University Hospital, Gent, Belgium
      ¶¶Department of Dermatology, Jichi Medical School, Tochigi, Japan
      ***Clinical Research Department, Novartis Pharma AG, Basel, Switzerland, and Department of Dermatology, Mulhouse General Hospital, Mulhouse, France
      †††Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
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  • J.M. Naeyaert,

    1. Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
      *Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France
      †Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
      ‡Department of Dermatology, University of Wales College of Medicine, Cardiff, UK
      §Department of Dermatology, University of Milan, Milan, Italy
      ¶Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
      **Clinical Pharmacology, Barts and The London, University of London, UK
      ††Department of Dermatology, University of Athens, A.Sygros Hospital, Athens, Greece
      ‡‡Department of Nephrology and Transplantation, Medizinische Klinik III, Zentralkrankenhaus, Bremen, Germany
      §§Department of Dermatology, Ghent University Hospital, Gent, Belgium
      ¶¶Department of Dermatology, Jichi Medical School, Tochigi, Japan
      ***Clinical Research Department, Novartis Pharma AG, Basel, Switzerland, and Department of Dermatology, Mulhouse General Hospital, Mulhouse, France
      †††Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
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  • H. Nakagawa,

    1. Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
      *Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France
      †Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
      ‡Department of Dermatology, University of Wales College of Medicine, Cardiff, UK
      §Department of Dermatology, University of Milan, Milan, Italy
      ¶Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
      **Clinical Pharmacology, Barts and The London, University of London, UK
      ††Department of Dermatology, University of Athens, A.Sygros Hospital, Athens, Greece
      ‡‡Department of Nephrology and Transplantation, Medizinische Klinik III, Zentralkrankenhaus, Bremen, Germany
      §§Department of Dermatology, Ghent University Hospital, Gent, Belgium
      ¶¶Department of Dermatology, Jichi Medical School, Tochigi, Japan
      ***Clinical Research Department, Novartis Pharma AG, Basel, Switzerland, and Department of Dermatology, Mulhouse General Hospital, Mulhouse, France
      †††Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
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  • C. Paul,

    1. Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
      *Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France
      †Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
      ‡Department of Dermatology, University of Wales College of Medicine, Cardiff, UK
      §Department of Dermatology, University of Milan, Milan, Italy
      ¶Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
      **Clinical Pharmacology, Barts and The London, University of London, UK
      ††Department of Dermatology, University of Athens, A.Sygros Hospital, Athens, Greece
      ‡‡Department of Nephrology and Transplantation, Medizinische Klinik III, Zentralkrankenhaus, Bremen, Germany
      §§Department of Dermatology, Ghent University Hospital, Gent, Belgium
      ¶¶Department of Dermatology, Jichi Medical School, Tochigi, Japan
      ***Clinical Research Department, Novartis Pharma AG, Basel, Switzerland, and Department of Dermatology, Mulhouse General Hospital, Mulhouse, France
      †††Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
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  • F. Vanaclocha

    1. Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
      *Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France
      †Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
      ‡Department of Dermatology, University of Wales College of Medicine, Cardiff, UK
      §Department of Dermatology, University of Milan, Milan, Italy
      ¶Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
      **Clinical Pharmacology, Barts and The London, University of London, UK
      ††Department of Dermatology, University of Athens, A.Sygros Hospital, Athens, Greece
      ‡‡Department of Nephrology and Transplantation, Medizinische Klinik III, Zentralkrankenhaus, Bremen, Germany
      §§Department of Dermatology, Ghent University Hospital, Gent, Belgium
      ¶¶Department of Dermatology, Jichi Medical School, Tochigi, Japan
      ***Clinical Research Department, Novartis Pharma AG, Basel, Switzerland, and Department of Dermatology, Mulhouse General Hospital, Mulhouse, France
      †††Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
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  • This report has been generated from the ‘Ciclosporin in Psoriasis Clinical Practice’ consensus conference held in Paris, France, on 5 September 2003. It involved experts in dermatology, clinical pharmacology and nephrology. The purpose of the conference was to develop a consensus statement on the clinical role of ciclosporin in the treatment of psoriasis. This conference was supported by an unrestricted educational grant from Novartis Pharma AG.

Professor Christopher Griffiths, Dermatology Centre, University of Manchester Irving Building, Hope Hospital, Salford, Manchester, M6 8HD, UK. E-mail: christopher.griffiths@man.ac.uk.

Summary

The main recommendations for the use of ciclosporin in the management of psoriasis are: (i) intermittent short courses (average of 12 weeks duration) of ciclosporin are preferable; (ii) ciclosporin should be given in the dose range 2·5–5·0 mg kg−1 day−1 (doses greater than 5·0 mg kg−1 day−1 should only be given in exceptional circumstances); (iii) treatment regimens should be tailored to the needs of each patient; (iv) selection of patients should take into account psychosocial disability, as well as clinical extent of disease and failure of previous treatment; (v) each patient's renal function (as measured by serum creatinine) should be thoroughly assessed before and during treatment; (vi) each patient's blood pressure should be carefully monitored before and during treatment; (vii) adherence to treatment guidelines substantially reduces the risk of adverse events; (viii) long-term continuous ciclosporin therapy may be appropriate in a subgroup of patients; however, duration of treatment should be kept below 2 years whenever possible; and (ix) when long-term continuous ciclosporin therapy is necessary, annual evaluation of glomerular filtration rate may be useful to accurately monitor renal function.

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