Management of Cyclosporine Therapy Based on the TDM (therapeutic Drug Monitoring) for Psoriasis

Abstract

The clinical efficacy of cyclosporine (CYA) therapy for psoriasis has been established. However, side effects associated with toxicity of CYA have been also discussed. It may be important to determine CYA dosage based on the TDM for psoriasis, in order to have more therapeutic success without adverse events. In this study, we investigated the possibility of using the TDM as a therapeutic marker for psoriasis treatment with CYA-MEPC (Neoral). Twenty-two patients with psoriasis vulgaris were given 3.0mg/kg/day Neoral twice per day. We measured 4 points (C₀ (base levels), C₁ (1hr post dose), C₂ (2hr post dose), andC₄ (4hr post dose)) of pharmacokinetics during the 4 hours following administration of the drug and calculated AUC_0-4 (area under concentration-time curve 0-4 hr). The relationships between AUC_0-4 and C₀, C₁, C₂, C₄ were analyzed. There was a correlation between C₂ and AUC_0-4 (r=0.87, p<0.001). AUC_0-4 correlations with clinical events during cyclosporine treatment were recognized in transplant recipient patients. These results suggest that C₂ monitoring is important for determining CYA dosage based on the TDM for psoriasis.