Aims: To compare the efficacy of ciclosporine (CsA) versus mycophenolate mofetil (MMF) in psoriasis, a randomized trial was conducted. Methods: A prospective multicenter randomized open-label clinical trial was performed to compare two parallel groups of patients with chronic plaque psoriasis undergoing different treatments. Therefore, a total of 54 patients with psoriasis were randomly assigned to treatment with either CsA (2.5 mg/kg body weight) or MMF (2 g daily) for 12 weeks, and the drug doses were adjusted according to response. The psoriasis area and severity index (PASI) was used to assess the clinical severity of psoriasis. The primary outcome of this trial was the time to disease relapse. Safety, PASI scores and psoriasis disability index (PDI) were assessed as secondary outcome. Results: There was no difference in time to disease relapse between the two groups. After 12 weeks of treatment, the mean PASI score (±SD) decreased from 24.6 ± 11.1 to 6.6 ± 7.3 in the CsA group (n = 27) and from 22.4 ± 9.2 to 10.6 ± 6.7 in the MMF group (n = 27; p = 0.02). The side effects, time to remission and PDI were similar in both groups. Conclusions: After 12 weeks, CsA demonstrated a significantly superior efficacy in psoriasis compared to MMF.

Gottlieb AB, Krueger JG, Wittkowski K, Dedrick R, Walicke PA, Garovoy M: Psoriasis as a model for T-cell-mediated disease: immunobiologic and clinical effects of treatment with multiple doses of efalizumab, an anti-CD11a antibody. Arch Dermatol 2002;138:591–600.
Koo J: Population-based epidemiologic study of psoriasis with emphasis on quality of life assessment. Dermatol Clin 1996;14:485–496.
Krueger JG: The immunologic basis for the treatment of psoriasis with new biologic agents. J Am Acad Dermatol 2002;46:1–23.
Schön MP, Boehncke WH: Psoriasis. N Engl J Med 2005;352:1899–1912.
Gelfand JM, Troxel AB, Lewis JD, et al: The risk of mortality in patients with psoriasis: results from a population-based study. Arch Dermatol 2007;143:1493–1499.
Schön MP: Advances in psoriasis treatment. Lancet 2005;366:1367–1374.
Weinstein GD, White GM: An approach to the treatment of moderate to severe psoriasis with rotational therapy. J Am Acad Dermatol 1993;28:454–459.
Sabat R, Philipp S, Hoflich C, et al: Immunopathogenesis of psoriasis. Exp Dermatol 2007;16:779–798.
Schön MP: Animal models of psoriasis: a critical appraisal. Exp Dermatol 2008;17:703–712.
Berth-Jones J, Voorhees JJ: Consensus conference on cyclosporin A microemulsion for psoriasis, June 1996. Br J Dermatol 1996;135:775–777.
Flytström I, Stenberg B, Svensson A, Bergbrant IM: Methotrexate vs ciclosporin in psoriasis: effectiveness, quality of life and safety. A randomized controlled trial. Br J Dermatol 2008;158:116–121.
Heydendael VM, Spuls PI, Opmeer BC, et al: Methotrexate versus cyclosporine in moderate-to-severe chronic plaque psoriasis. N Engl J Med 2003;349:658–665.
Ho VC, Griffiths CE, Albrecht G, et al: Intermittent short courses of cyclosporin (Neoral®) for psoriasis unresponsive to topical therapy: a 1-year multicentre, randomized study. The PISCES Study Group. Br J Dermatol 1999;141:283–291.
Koo J: A randomized, double-blind study comparing the efficacy, safety and optimal dose of two formulations of cyclosporin, Neoral and Sandimmun, in patients with severe psoriasis. OLP302 Study Group. Br J Dermatol 1998;139:88–95.
Sandhu K, Kaur I, Kumar B, Saraswat A: Efficacy and safety of cyclosporine versus methotrexate in severe psoriasis: a study from north India. J Dermatol 2003;30:458–463.
Spuls PI, Witkamp L, Bossuyt PM, Bos JD: A systematic review of five systemic treatments for severe psoriasis. Br J Dermatol 1997;137:943–949.
Epinette WW, Parker CM, Jones EL, Greist MC: Mycophenolic acid for psoriasis: a review of pharmacology, long-term efficacy, and safety. J Am Acad Dermatol 1987;17:962–971.
Jones EL, Epinette WW, Hackney VC, Menendez L, Frost P: Treatment of psoriasis with oral mycophenolic acid. J Invest Dermatol 1975;65:537–542.
Marinari R, Fleischmajer R, Schragger AH, Rosenthal AL: Mycophenolic acid in the treatment of psoriasis: long-term administration. Arch Dermatol 1977;113:930–932.
Haufs MG, Beissert S, Grabbe S, Schütte B, Luger TA: Psoriasis vulgaris treated successfully with mycophenolate mofetil. Br J Dermatol 1998;138:179–181.
Zhou Y, Rosenthal D, Dutz J, Ho V: Mycophenolate mofetil (Cellcept) for psoriasis: a two-center, prospective, open-label clinical trial. J Cutan Med Surg 2003;7:193–197.
Fredriksson T, Pettersson U: Severe psoriasis – oral therapy with a new retinoid. Dermatologica 1978;157:238–244.
Finlay AY, Kelly SE: Psoriasis – an index of disability. Clin Exp Dermatol 1987;12:8–11.
Finlay AY, Khan GK, Luscombe DK, Salek MS: Validation of Sickness Impact Profile and Psoriasis Disability Index in psoriasis. Br J Dermatol 1990;123:751–756.
Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–481.
Peto R, Peto J: Asymptomatically efficient rank invariation test procedures (with discussion). J R Stat Soc A 1972;135:185–206.
Sterry W, Barker J, Boehncke WH, et al: Biological therapies in the systemic management of psoriasis: international consensus conference. Br J Dermatol 2004;151(suppl 69):3–17.
Lebwohl M, Ellis C, Gottlieb A, et al: Cyclosporine consensus conference: with emphasis on the treatment of psoriasis. J Am Acad Dermatol 1998;39:464–475.
Berth-Jones J, Henderson CA, Munro CS, et al: Treatment of psoriasis with intermittent short course cyclosporin (Neoral): a multicentre study. Br J Dermatol 1997;136:527–530.
Griffiths CE, Powles AV, McFadden J, Baker BS, Valdimarsson H, Fry L: Long-term cyclosporin for psoriasis. Br J Dermatol 1989;120:253–260.
Behrend M: Adverse gastrointestinal effects of mycophenolate mofetil: aetiology, incidence and management. Drug Saf 2001;24:645–663.
Lipsky JJ: Mycophenolate mofetil. Lancet 1996;348:1357–1359.
Davison SC, Morris-Jones R, Powles AV, Fry L: Change of treatment from cyclosporin to mycophenolate mofetil in severe psoriasis. Br J Dermatol 2000;143:405–407.
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