A busy clinician's review of cyclosporine - Veterinary Medicine
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A busy clinician's review of cyclosporine
This oral immunosuppressive drug used to treat canine atopy is probably already in your armamentarium. But do you know which formulation to avoid, how obesity affects the dose, or when to decrease the dosage?


VETERINARY MEDICINE


DERMATOLOGIC USES

Cyclosporine has been used to treat a wide range of inflammatory and immune-mediated skin diseases including canine and feline atopic dermatitis, feline eosinophilic granuloma complex, cutaneous lupus erythematosus, feline pseudopelade (noninflammatory alopecia in which hair loss is usually permanent), pemphigus foliaceus and erythematosus, sebaceous adenitis, perianal fistula, sterile nodular panniculitis, dirty face syndrome (Persian cats), chronic pedal furunculosis, erythema multiforme, follicular hyperkeratosis, German shepherd deep pyoderma, sterile pyogranulomatous syndrome, alopecia areata, and proliferative otitis externa.6 For some of these diseases, strong evidence exists that the drug is efficacious; however, for most of the other diseases, reports of efficacy are limited to single cases or anecdotal reports. Of these diseases, cyclosporine (Atopica) is FDA-approved only for use in dogs with atopic dermatitis. This drug is also approved in some countries outside the United States.


1. Self-trauma resulting from atopic dermatitis in a 3-year-old cat. Note the preauricular erythema.
The primary use of cyclosporine in clinical practice is in treating atopic dermatitis. However, we would also like to briefly describe its use in treating sebaceous adenitis and perianal fistulas.

Atopic dermatitis


2. The same cat as above. Note the papular eruption and facial inflammation caused by facial rubbing.
Atopic dermatitis is one of the most common pruritic skin diseases in dogs and cats (Figures 1 & 2). While diagnosing atopic dermatitis is beyond the scope of this article, it is imperative that you definitively diagnose it by ruling out other causes of pruritus (e.g. a parasitic or bacterial infection, a food or flea allergy).before starting treatment. Allergy testing (intradermal or in vitro testing) may not be needed to confirm the diagnosis, but it is necessary to formulate an allergen-specific immunotherapy protocol.


Cyclosporine therapy: Things to consider before prescribing
When deciding on a treatment plan, considerations include the duration and severity of clinical signs, whether the pet is a working animal (e.g. avoid drugs such as antihistamines that may interfere with a guide dog's ability to stay alert), and concurrent medical conditions (e.g. diabetes mellitus). Other considerations are described in the boxed text "Cyclosporine therapy: Things to consider before prescribing."

Efficacy in studies. Cyclosporine is the newest option available for treating atopic dermatitis, and numerous reports have evaluated its use.11-13

In a systematic review and meta-analysis, 799 dogs in 10 studies had been treated with cyclosporine (n=672), placebo (n=160), oral glucocorticoids (n=74), or antihistamines (n=23).11 Dogs were treated from two weeks to six months, and doses were 2.5 to 5 mg/kg.

After four to six weeks of cyclosporine (5 mg/kg once daily), a 40% decrease in skin lesions and at least a 30% decrease in pruritus were noted. The percentage of dogs showing at least a 50% improvement in clinical signs increased from 20% to 60% after four weeks of treatment and from 63% to 87% after 12 to 16 weeks of therapy.

At the end of four weeks, in most of the studies, 40% to 50% of dogs had their cyclosporine dosage reduced to every other day, and in 20% to 26% of dogs, dosages could be reduced to twice weekly after 14 to 16 weeks of therapy. When cyclosporine was compared with placebo, a significant difference in efficacy was noted; however, no significant difference was noted when cyclosporine was compared with glucocorticoids.


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Source: VETERINARY MEDICINE,
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