Mechanism of amifostine combined with low dose cyclosporine in refractory immune thrombocytopenia / 中国生化药物杂志

Objective To explore the effect of amifostine combined with low-dose cyclosporine in treatment of refractory immune thrombocytopenia effect and related mechanisms.Methods 60 cases of refractory immune thrombocytopenia patients using parallel randomized controlled groups, divided into three groups, 20 cases in each group, amifostine group were treated with amifostine, cyclosporine group were treated with cyclosporine, amifostine+CSA group received amifostine+cyclosporine A treatment.The platelet count, platelet membrane glycoprotein antibody, lymphocyte subsets and bone marrow megakaryocyte count were observed and compared.Results After different treatment of three, six months, the level of platelet count of patients in three groups were compared with the group before treatment were significantly increased, and the treatment of platelet count level of amifostine group and cyclosporine group were significantly lower than that of amifostine +CSA group, the difference was statistically significant (P<0.05), there was no significant difference between amifostine group and cyclosporine group.The total efficacy of amifostine+CSA group was significantly higher than the other two groups, the difference was statistically significant ( P<0.05 ) , there was no significant difference between amifostine group and cyclosporine group.After the treatment, the platelet membrane glycoprotein GPIIb/IIIa antibody levels in three groups were significantly increased, and ring the detection level of amifostine+CSA group after treatment was significantly higher than the other two groups, the difference was statistically significant (P<0.05), there was no significant difference between amifostine group and cyclosporine group.After treatment, the three groups of CD4 +, CD4 +/CD25 +and CD4 +/CD8 +levels were significantly increased, CD8 +decreased significantly, the difference was statistically significant (P<0.05).And the level of change after treatment with amifostine +cyclosporine group was significantly higher than that of the other two groups, the difference was statistically significant (P<0.05), there was no significant difference between amifostine group and cyclosporine group.After treatment, the number of bone marrow megakaryocytes in the three groups was significantly lower than that before treatment , the level of count after treatment with amifostine +cyclosporine was significantly lower than that of the other two groups, the difference was statistically significant (P<0.05).there was no significant difference between amifostine group and cyclosporine group.The adverse reactions of amifostine group and amifostine+CSA group were significantly lower than that in cyclosporine group, the difference was statistically significant (P<0.05).there was no significant difference between amifostine group and amifostine+CSA group.Conclusion Amifostine combined with low dose of cyclosporine in treatment of refractory immune thrombocytopenia can play a synergistic effect, improve the therapeutic effect, and effectively reduce the dosage and adverse reactions.

The Efficacy, Safety and Long-term Effect of Cyclosporine for Treating Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: The efficacy and safety of cyclosporine for the treatment of chronic idiopathic urticaria (CIU) have been studied in numerous trials, but there have been few studies on the long-term effect of cyclosporine. OBJECTIVE: This study was aimed to assess the efficacy and safety of low-dose cyclosporine for treating CIU. Furthermore, its long-term effect on the natural course of CIU was investigated. METHODS: Thirty patients who suffered from persistent CIU despite conventional treatments received 2~3 mg/kg/day of cyclosporine for 12 weeks. The severity score was assessed by means of the urticaria activity score and the visual analogue score at baseline and at weeks 2, 4, 8 and 12. The safety assessments consisted of reporting the side effects and monitoring the laboratory parameters. After a follow-up period of at least 1 year, the patients were asked whether they had any remaining or new symptoms and whether they still used antihistamines or any other drugs. RESULTS: Twenty seven patients completed the trial medication, and the respective symptom scores significantly improved after 12 weeks. Four (14.8%) patients reported adverse events during the trial period, but the events were not severe enough to require withdrawal from the study. Of the twenty one patients who were followed for at least 1 year (range: 12~45 months) after the completion of cyclosporine administration, eight patients (38.1%) were symptom free, and seven patients (33.3%) used only antihistamines. CONCLUSION: This study shows that low-dose cyclosporine is an efficacious and safe treatment option for treating CIU. In addition, the preliminary results suggest that low-dose cyclosporine might be helpful for the long-term control of this disease.

The Efficacy, Safety and Long-term Effect of Cyclosporine for Treating Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: The efficacy and safety of cyclosporine for the treatment of chronic idiopathic urticaria (CIU) have been studied in numerous trials, but there have been few studies on the long-term effect of cyclosporine. OBJECTIVE: This study was aimed to assess the efficacy and safety of low-dose cyclosporine for treating CIU. Furthermore, its long-term effect on the natural course of CIU was investigated. METHODS: Thirty patients who suffered from persistent CIU despite conventional treatments received 2~3 mg/kg/day of cyclosporine for 12 weeks. The severity score was assessed by means of the urticaria activity score and the visual analogue score at baseline and at weeks 2, 4, 8 and 12. The safety assessments consisted of reporting the side effects and monitoring the laboratory parameters. After a follow-up period of at least 1 year, the patients were asked whether they had any remaining or new symptoms and whether they still used antihistamines or any other drugs. RESULTS: Twenty seven patients completed the trial medication, and the respective symptom scores significantly improved after 12 weeks. Four (14.8%) patients reported adverse events during the trial period, but the events were not severe enough to require withdrawal from the study. Of the twenty one patients who were followed for at least 1 year (range: 12~45 months) after the completion of cyclosporine administration, eight patients (38.1%) were symptom free, and seven patients (33.3%) used only antihistamines. CONCLUSION: This study shows that low-dose cyclosporine is an efficacious and safe treatment option for treating CIU. In addition, the preliminary results suggest that low-dose cyclosporine might be helpful for the long-term control of this disease.

A Case of Generalized Lichen Nitidus Treated with Low Dose Cyclosporine / 대한피부과학회지

Lichen nitidus is a rare and chronic inflammatory dermatosis first described by Pinkus in 1907. The etiology of it is still unknown and the majority of instances appear in children and young adults. The lesions are usually asymptomatic but may be mildly pruritic and the Koebner phenomenon may be observed. It is characterized by flesh-colored, minute, shiny papules occurring on the genitalia, abdomen, chest, and extremities. This disorder is most often localized, but there are rare reports of patients having a more generalized distribution of lesions. Although lichen nitidus is self-limited in most cases without any sequelae, the course of generalized lichen nitidus is unpredictable. We report a case of a 16-year-old girl diagnosed by generalized lichen nitidus refractory to general treatment and successfully treated with low dose cyclosporine (2 mg/kg/day).

Therapeutic Efficacy of Low-dose Cyclosporine in Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: Chronic idiopathic urticaria (CIU) has a major impact on patients' quality of life. However the management of CIU has sometimes been challenging to physicians, with little response to conventional therapy like antihistamines. OBJECTIVE: This study was aimed to determine the effectiveness and safety of low-dose cyclosporine for the treatment of recalcitrant CIU with a positive autologous serum skin test (ASST). METHODS: Thirty CIU patients who were unresponsive to conventional antihistamine therapy were treated for 3 consecutive months with low-dose cyclosporine (2~3 mg/kg/day) and fexofenadine (180 mg/day). The clinical efficacy was measured at baseline, week 1, 2, and month 1, 2 and 3. CIU sign and symptom scores were assessed using 4-point scales for pruritus, number of hives, size of largest hive, interference with sleep, and interference with daily activities. Global assessment of the severity by patients and any side effects were also measured at every visit. RESULTS: Low-dose cyclosporine significantly improved the total CIU scores. In addition, the interference with sleep was reduced and the performance of daily activities improved in accordance with patient's global assessment of urticaria severity after 3 month of treatment. Moreover there were no significant side effects to suggest stopping cyclosporine administration. CONCLUSION: These results show that low-dose cyclosporine therapy might be a good therapeutic alternative in CIU patients who are unresponsive to conventional treatments.