The Th2 cytokine inhibitor, suplatast tosilate 300mg/day was administered to 163 patients with atopic dermatitis who had been poorly controlled by other anti-allergic drugs. The usefulness of suplatast tosilate was evaluated with respect to skin symptom score and parameters such as IgE, eosinophil and basophil counts, and LDH. After 4 weeks of treatment, the skin symptom score, eosinophil counts and LDH were significantly decreased, whereas other parameters remained unchanged.

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We investigated the effects of oral Suplatast tosilate(IPD), the selective Th2 cytokine suppressor, on adult atopic dermatitis(AD). We divided the patients into two groups;
(1)IPD+topical ointment (IPD group) and (2) antiallergic drug+topical ointment or topical ointment alone (control groups), and evaluated skin symptoms, serum immunoglobulin E level, LDH level, and the number of eosinophils and basophils. Although there were no significant improvement of laboratory data, skin symptoms improved in both groups.
Especially in high value of immunoglobulin E and basophils patients, the IPD group showed significant improvement of skin symptoms compared with the control group.
Therefore, we suggest that IPD may be more effective to the patients with high value of immunoglobulin E and basophils.

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An investigation of clinical effects and suppression of IgE production via treatment with the Th2 cytokine inhibitor suplatast tosilate (IPD)in atopic dermatitis was conducted. The number of cases was small, and statistical analysis was not possible. However, tendencies towards improved serum IgE levels and eosinophil number were not particularly evident with suplatast tosilate treatments of six months or more, improvements were noted in clinical results for itching and visible skin symptoms with treatments of one to a few months. This trend was stronger in cases treated for one to a few months than in those treated for six months or more. However, in the control group, which was treated with an anti-allergic medication other than suplatast tosilate for six months or more, a tendency towards improved clinical results was also noted.
Treatment with anti-allergic medication is considered an effective means of improving clinical results for atopic dermatitis. In cases which skin rash or itching do not change or worsen, treatment for one to a few months with suplatast tosilate is likely to be effective in improving clinical results.

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A Japanese woman in her forties complained of one-year history of episodic painful angioedema on her extremities associated with myalgia and dysesthesia. She also had a three-year history of bronchial asthma. Peripheral eosinophilia, and respiratory as well as cutaneous symptoms led to a diagnosis of hypereosinophilic syndrome. Her symptoms responded well to initial doses of oral corticosteroids but could not be maintained with low-doses of corticosteroids, experiencing relapses, often in the setting of corticosteroid tapering with an increasing eosiophil count. Suplatast tosilate was then commenced, added to oral corticosteroid, and led to a significantly reduced incidence of relapses with a decreasing eosinophil count. Suplatst tosilate can be a useful add-on therapy in patients who experience relapses.

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Atopic diseases may have been associated with the exacerbation of alopecia areata(AA), because it often complicate with recurrent and intractable alopecia areata. In this study, we examined the efficacy of Suplatast tosilate, the selectively suppressor of Th2 cytokine, in 7 AA patients with atopy.
In result, 4 patients improved and serum immunoglobulin E levels decreased in those patients

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We administered suplatast tosilate (IPD) for 14 atopic dermatitis patients who showed resistance to previous drug treatment, and examined clinical obserbation, serum IgE level, eosinophil number, basophil number and LDH. After four or more week treatment of IPD, skin severity score was improved in six of 14 patients. Especially in two patients, IPD showed remarkably improvement effect. IPD significantly decreased the basophil number but not influenced other blood parameters.

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Since atopic dermatitis (AD) has a psychosocial impact on both patients and their family, it is important to evaluate patients’ quality of life (QOL) as well as their clinical condition when treating AD. We investigated the clinical efficacy, safety, and effect on patients’ QOL of concurrent treatment with a Th2 cytokine inhibitor (suplatast tosilate) in an open-label trial in 18 adult AD patients with mild to moderate disease who were resistant to previous standard treatments for AD. The patients also applied corticosteroid ointment or tacrolimus ointment topically as needed. The global assessments after treatment revealed “moderately improved” or better in 13 (72.2%) of the 18 patients. Both the skin scores and pruritis had improved significantly. The quantity of topical corticosteroid ointment required decreased significantly during the course of treatment. Evaluation according to the Dermatology Life Quality Index (DLQI) revealed that treatment with suplatast tosilate significantly improved the QOL of the AD patients, especially their symptoms and feelings. The regimen of concurrent treatment with a Th2 cytokine inhibitor (suplatast tosilate) and standard treatment for AD in this study was an effective treatment for resistant AD and significantly improved the patients’ QOL.

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Besides having an inhibitory effect of chemical mediator release from mast cells, IPD has an inhibitory effect of Th2 cytokines (IgE production by IL-4 inhibition and eosinophil proliferation by IL-5 inhibition). We administered IPD to patients with atopic dermatitis and evaluated the blood levels of IgE and eosinophil counts. IPD significantly improved the severity of the skin, but did not influence the IgE production and eosinophil number. However, IPD potently decreased the levels of IgE in 2 patients with marked hyperimmunoglobulinemia E. These results suggest that IPD is markedly useful in a certain group of patients with atopic dermatitis.

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A 22-year-old man was referred to our clinic because of a severe skin eruption, which was diagnosed as atopic dermatitis in childhood and treated with various therapeutic modalities. On examination, he had a generalized eczematous eruption with an exudative change. His face was reddish, pigmented and exudative as well. The patient was treated with oral olopatadine and topical steroid. Although the exudative change was reduced by this therapy, his eruption still remained with newly developed erythematous lesions. Thus, we treated him additionally with oral suplatast tosilate, which remarkably improved the skin lesions. Along with reduction of the skin severity index, IgE was decreased from 8,000 to 3,673 units/ml, and the number of eosinophils from 10.7 to 5.6%. Our case demonstrated that suplatast tosilate exerts a therapeutic effectiveness for atopic dermatitis as IgE depressor more efficaciously in combination with another complementary drug.

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For adult atopic dermatitis patients, the effect of Suplatast Tosilate was examined by clinical observation, IgE level, LDH, eosinophil number, and serum concentrations of eotaxin2 and IP-10. We treated patients with either Suplatast Tosilate or other anti allergic agents (control group). The clinical observation was improved in both groups, but the decrease in serum IgE level could not be detected. By contrast, the significant decrease in LDH was observed only in the Suplatast Tosilate-administrated group. Furthermore, eosinophil number decreased. However, the decline of LDH and eosinophil number could not be found in the control group. In the Suplatast Tosilate-administrated group, eotaxin2 was decreased in 2 out of 4 serum samples, and it was unchangeable in the 1 serum sample. In the average, mean eotaxin2 level decreased from 212.6 pg/ml to 167.9pg/ml. These results suggest that Suplatast Tosilate exhibits inhibitory effect for Th2 chemokine in adult atopic dermatitis.

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A 30-year-old man, who developed atopic dermatitis at 15 years of age, had been suffered from severe recalcitrant erythema of the face and head, especially during this year. He showed a normal level of serum IgE and had no past and family history of other types of atopic diseases, which indicate that this case is non-allergic type of atopic dermatitis. Oral administration of IPD had relieved his symptom within two months, and the most of symptom disappeared nine months later. In the literature, we found additional four cases of non-allergic type atopic dermatitis whose clinical scores were improved by IPD. These suggest that IPD might be effective for non-allergic type of atopic dermatitis as well as allergic type of that. Functions other than a Th2 cytokine inhibitor of IPD might be involved in the therapeutic effect.

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