Cyclosporin A Treatment in Psoriasis: Monitoring by Neopterin Concentrations In Serum and Urine

Psoriasis is a hyperproliferative skin disorder in which immune mechanisms are thought to play a role. Recently, cyclosporin A has been found effective to treat psoriasis. However, mechanisms of action of cyclosporin A in patients are not well understood. We investigated seven patients (6 males. 1 female, aged 29-58 years) with severe psoriasis, three of them associated with arthropathy. The patients were treated with cyclosporin A given twice daily in gelatine capsules. Four patients were given 5 mg/kg, the others received 2.5 mg/kg initially. Two of them were put on 5 mg/kg (after 4 and 12 weeks of treatment). Clinical evaluation before and during therapy was carried out using the Psoriasis Area and Severity Index (PASI). Patients were followed up for 6 and 15 months. Their cyclosporin A blood levels were adjusted by a monoclonal radioimmunoassay. In parallel, serum and urine neopterin levels were quantified by HPLC. Mean neopterin concentrations in patients prior to therapy were found only slightly higher (serum 6.5± 0.8 mmol/l) than in healthy controls. There was no correlation of neopterin values and the degree of PASIscore. Onset of cyclosporin A was paralleled by decreasing neopterin concentrations and improvement of the skin status. Decrease of cyclosporin A doses was accompanied by an increase of PASI and significantly decreasing neopterin levels. In patients with severe relapses of psoriasis after withdrawal of cyclosporin A, neopterin rose higher than pretreatment levels. In 6/7 patients PASI and neopterin levels were closely correlated