Diet plus low-dose cyclosporine very effective in obese psoriasis patients.
The clinical implication of this finding? "A global approach to obese patients with severe psoriasis should include body weight reduction," said Dr. Gisondi, of the University of Verona (Italy).
He presented the results of a randomized trial involving 60 patients with severe psoriasis and a body mass index of 30 kg/[m.sup.2] or more. All were placed on 2.5 mg/kg per day of cyclosporine, even though doses of less than 3 mg/kg are known to have poor efficacy. They were randomized to either a dietitian-administered low-calorie diet designed to achieve at least a 5%-10% weight loss or to usual care.
The primary study end point was at least a 75% reduction in Psoriasis Area and Severity Index score (PASI-75) at 24 weeks. By then, patients in the diet arm had lost a mean of 6.6 kg, whereas the controls' weight was unchanged. As patients lost weight, physicians adjusted their cyclosporine dosage to maintain it at 2.5 mg/kg.
A PASI-75 was achieved in 67% of the diet group, compared with 21% of controls. A PASI-50 was achieved by 86% of the diet group and 42% of controls, Dr. Gisondi said.
Obesity is more prevalent in patients with chronic plaque psoriasis than in the general population. The rationale for the dietary intervention hinged on prior reports that a calorie-restricted diet results in clinical improvement and reduces inflammatory markers in obese patients, he said.
In accord with the prior studies, C-reactive protein levels in the obese psoriasis patients were elevated at baseline and dropped significantly in the dietary intervention group.
Asked why he chose to prescribe suboptimal-dose cyclosporine in the study, Dr. Gisondi replied that it made it much easier to determine whether a weight-loss diet had a beneficial effect, because full-dose cyclosporine would predictably result in a high PASI-75 with or without the dietary intervention. Plus, low-dose cyclosporine means fewer side effects and less expense.
Session cochair Dr. Jean-Claude Roujeau commented that the trial would have been stronger had serial plasma cyclosporine levels been measured.
A low-calorie diet is typically rich in fruits and vegetables, some of which can increase absorption of the drug, so it's unclear how much of the observed clinical benefit was due to increased cyclosporine absorption as opposed to weight loss, said Dr. Roujeau, professor of dermatology at Henri Mondor University Hospital, Paris.
BY BRUCE JANCIN
Obese Psoriasis Patients Who Achieved a PASI-75 Diet group 67% Control group 21% Note: Based on a randomized 24-week study of 60 patients. Source: Dr. Gisondi ELSEVIER GLOBAL MEDICAL NEWS Note: Table made from bar graph.
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|Publication:||Internal Medicine News|
|Date:||Feb 15, 2008|
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