Enteric-coated mycophenolate sodium versus cyclosporin A as long-term treatment in adult patients with severe atopic dermatitis: A randomized controlled trial - 10/08/11
, Mirjam J. Knol, PhD b, Onno ten Berge, MD a, Sara G.A. van Velsen, MD a, Marjolein S. de Bruin-Weller, MD, PhD a, Carla A.F.M. Bruijnzeel-Koomen, MD, PhD a
Reprint requests: Inge M. Haeck, MD, University Medical Center, Inhouse post number G02.124, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.Abstract |
Background |
Cyclosporin A (CsA) is frequently used in the treatment of severe atopic dermatitis (AD). Enteric-coated mycophenolate sodium (EC-MPS) may be an alternative with equal efficacy and fewer side effects.
Objective |
The aim of this observer-blinded randomized controlled trial was to compare EC-MPS with CsA as long-term treatment in adult patients with severe AD.
Methods |
Fifty five patients with AD were treated with CsA (5 mg/kg) in a 6-week run-in period. Thereafter, patients either received CsA (3 mg/kg; n = 26) or EC-MPS (1440 mg; n = 24) during a maintenance phase of 30 weeks and there was a 12-week follow-up period. Disease activity was measured using the objective SCORAD and serum thymus and activation-regulated chemokine (TARC) levels and side effects were registered.
Results |
During the first 10 weeks the objective SCORAD and serum TARC levels in the EC-MPS study arm were higher in comparison with the CsA study arm. In addition, 7 of the 24 patients treated with EC-MPS required short oral corticosteroid courses. During maintenance phase disease activity was comparable in both study arms. Side effects in both study arms were mild and transient. After study medication withdrawal, disease activity of the patients in the CsA study arm significantly increased compared with the EC-MPS study arm.
Limitation |
The nonblinding of patients and prescriber of rescue medication are limitations.
Conclusions |
This study shows that EC-MPS is as effective as CsA as maintenance therapy in patients with AD. However, clinical improvement with EC-MPS is delayed in comparison with CsA. Clinical remission after stopping EC-MPS lasts longer compared with CsA.
Le texte complet de cet article est disponible en PDF.Key words : adults, atopic dermatitis, cyclosporin A, enteric-coated mycophenolate sodium, randomized controlled trial
Abbreviations used : AD, CI, CsA, EC-MPS, IL, MMF, MPA, TARC, VAS
Plan
| Supported by Novartis Pharma BV. |
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| Conflicts of interest: None declared. |
Vol 64 - N° 6
P. 1074-1084 - juin 2011 Retour au numéro
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