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Retrospective Review of Relapse after Systemic Cyclosporine in Children with Atopic Dermatitis

Authors

  • Cathryn Sibbald M.D.,

    Corresponding author
    1. Department of Dermatology, University of Toronto, Toronto, Ontario, Canada
    • Address correspondence to Cathryn Sibbald, M.D., Division of Dermatology, 2075 Bayview Avenue, M1-700, Toronto, ON M4N 3M5, Canada, or e-mail: Cathryn.sibbald@utoronto.ca.

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  • Elena Pope M.Sc., F.R.C.P.C.,

    1. Department of Dermatology, University of Toronto, Toronto, Ontario, Canada
    2. Section of Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada
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  • Nhung Ho M.D.,

    1. Department of Dermatology, University of Toronto, Toronto, Ontario, Canada
    2. Section of Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada
    3. Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
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  • Miriam Weinstein M.D., F.R.C.P.C.

    1. Department of Dermatology, University of Toronto, Toronto, Ontario, Canada
    2. Section of Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract

Cyclosporine is a systemic therapy used for control of severe atopic dermatitis (AD) in children. Although traditionally recommended at a dose of 5 mg/kg/day for 6 months, a longer duration of treatment may be necessary to bring a child with active and severe disease into remission. There are few data on the short- and long-term effectiveness of longer courses of therapy. This was a retrospective chart review of children treated with cyclosporine at a Canadian hospital-affiliated clinic between 2000 and 2013. Fifteen patients with adequate follow-up were identified. Twelve (80%) were male and the mean age at initiation of cyclosporine was 11.2 ± 3.4 years. The mean duration of cyclosporine therapy was 10.9 ± 2.7 months (range 7–15 months) at a starting dose of 2.8 ± 0.6 mg/kg/day. Of 12 patients (80%) who responded to cyclosporine, 5 patients (42%) had relapsed at a follow-up of 22.7 ± 15.0 months. The duration of therapy was longer in patients who did not relapse (17.7 ± 10.7 months) than in those who did (10.2 ± 2.7 months) (p = 0.06). Adverse events led to discontinuation in three patients (20%) and included infection-related complications in two patients and reversible renal toxicity in one. These results suggest that a longer duration of low-dose cyclosporine may help decrease the risk of relapse in patients with severe AD who are resistant to topical therapies.

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