아토피피부염 환자에서 Cyclosporine 치료용량 및 재발인자에 대한 후향적 연구

Abstract

Background: The clinical efficacy of cyclosporine in the treatment of atopic dermatitis is well documented. However, the optimal dose regimen has not yet been established, and there are few published data about the factors related with relapse after cyclosporine therapy. Objective: The purpose of this study was to provide clues for the proper use of cyclosporine and identify contributing factors for relapse in atopic dermatitis. Methods: We performed a retrospective analysis of 174 patients with atopic dermatitis who had been treated with cyclosporine in our clinic between January 2007 and January 2012. Results: The mean starting dose of cyclosporine was 4.8 mg/kg, and the relief of symptoms was initially achieved with a dose of 5.0 mg/kg. Treatments were continued for 137.2 days with a cumulative dose of 388.0 mg/kg. After discontinuation of cyclosporine, 79/167 (47.3%) patients experienced a relapse, and the duration of remission was 288.6 days. In a multiple regression analysis, serum IgE (p=0.015), starting dose of cyclosporine (p=0.010), and maintenance therapy (p＜0.001) were independent and significant factors related to relapse; the relapse and serum IgE, starting dose of cyclosporine showed negative relationship, and maintenance therapy considerably reduced the recurrence rate (odds ratio, 0.04). Conclusion: Our results indicate that higher starting dose of cyclosporine may decrease the relapse rate in atopic dermatitis. In the post-cyclosporine period, subsequent maintenance therapy should also be considered for sustained remission. At the beginning of cyclosporine therapy, initial serum IgE would be a good laboratory index for predicting the risk of relapse.