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Renal Function Not Always Severely Affected by Long-term Cyclosporin Treatment for Psoriasis: Presented at EADV

By Bonnie Darves

BARCELONA, SPAIN -- October 21, 2003 -- Patients with severe psoriasis who respond to and continue taking cyclosporin for long periods do not necessarily develop impaired renal function, but annual assessment via creatinine clearance is imperative, according to research presented here October 18^th at the European Academy of Dermatology & Venereology Congress.

Although cyclosporin has proved effective in treating refractory psoriasis, the drug's well documented adverse effects are a matter of concern to patients and their treating physicians, said lead investigator Nils-Jorgen Mork, National Hospital, Olso, Norway.

"There is no doubt that the drug works well in most of our patients, but the side effects are well known. Our major concern is the nephrotoxicity and, of course, the hypertension," he said, noting that previous studies showed that most patients develop some changes in renal function with long-term treatment.

In their 3-year study, Dr. Mork and colleagues assessed patients' renal function and other parameters to determine the extent to which CS treatment might contribute to worsening renal function. Patients, who received a dose of 3.2 mg daily initially and were taking 3.5 mg at the end of the study, had a mean cyclosporin concentration of 220.

Renal function testing occurred at baseline and at 6-month intervals, through creatinine clearance and albumin excretion, along with assessment of markers NAG and ALP (D-glucosaminidase and alkaline phosphatase, respectively) for tubular toxicity.

Thirteen patients completed the study; three withdrew because of worsening renal function, Dr. Mork noted, a finding that surprised the researchers. "Although we saw an increase in blood pressure over the 3 years, we concluded that the markers for tubular toxicity were stable," he said. "The serum creatinine was almost unchanged, and we were surprised by that."

Although the creatinine clearance method may overestimate glomerular filtration rate when compared to iothalamate clearance, Dr. Mork noted, both methods were more reliable than serum creatinine in helping identify patients with impaired renal function. Despite that, he recommends that dermatologists whose patients are on long-term cyclosporin should assess creatinine clearance annually and should also check the clearance when a modest increase in creatinine clearance occurs. He added that the researchers did not perform kidney biopsies during the course of the study.


[Study title: Long-term Renal Function During Cyclosporin Treatment For Severe Psoriasis. Podium FC2-3]

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