피부질환 치료에서의 경구 Cyclosporine의 부작용에 대한 연구

Abstract

Background: In dermatology, cyclosporine (CS) has been used successfully as primary or secondary therapy for various skin diseases including psoriasis, atopic dermatitis, and chronic idiopathic urticaria. However, many dermatologists have hesitated to use this important drug in their clinical practices because of its adverse effects. Objective: The aim of this study was to investigate the adverse effects of CS for dermatological uses. Methods: We performed a retrospective study of 1,335 patients with CS treatment in Department of Dermatology, Hanyang University Hospital between January 1, 2008 and December 31, 2012. Results: Of 1,335 patients, 208 patients (15.6%) and 238 cases showed adverse effects and obvious laboratory changes. 25 patients experienced two or more adverse effects. Gastrointestinal (GI) symptoms were the most common adverse effect, it occurred in 107 patients (8.0%). Other side effects were as follows; hypercholesterolemia (2.2%), hypertrichosis (2.2%), headache (1.3%), hypertension (0.9%), hypertriglyceridemia (0.9%), paraesthesia (0.6%), increased creatinine levels (0.4%), tremor (0.3%), infection (0.1%), in order of frequency. Hypercholesterolemia occurred more often in men but, GI symptoms and hypertrichosis in women. Hypercholesterolemia, hypertriglyceridemia, and GI symptoms were more common in adults but hypertrichosis in children and adolescent. Hypertension, hypercholesterolemia, and hypertriglyceridemia have been remarkable in psoriasis patients, and GI symptoms and hypertrichosis in patients with atopic dermatitis. GI symptoms and headache occurred more often within three months of CS treatment, however, hypertension, hypercholesterolemia, and hypertriglyceridemia three months after. With reference to CS dose, hypertrichosis was more often in group with low initial dose. GI symptoms occurred more often in lower CS cumulative dose group, however, hypertension and hypertriglyceridemia in higher CS cumulative dose group. Conclusions: Compared with previous studies, the frequency of adverse effects after CS treatment in this study was proven to be low. Therefore, in dermatologic field, we suggest that CS is a relatively safe drug with periodic follow-up and laboratory test including kidney function test and lipid profile.