Some authors prefer to start at full dosages until the achievement of remission and then gradually taper the dosage, adjusting it only in case of adverse reactions (step-down regimen). Others, conversely, advise to start with daily doses of 2.5�C3mg/kg and gradually build up the dose by 0.5�C1mg/kg/day selleck kinase inhibitor every 2�C4 weeks in the event of nonresponse, carefully monitoring tolerability (step-up regimen) [8, 15, 19, 20]. The outcomes of such different regimens were analysed by a 12-week, prospective, open-label study in 61 severe psoriasis patients [21]. Patients were assigned to a 2.5mg/kg/day starting dose and an increasing ��step-up�� regimen or a 5.0mg/kg/day starting dose and a decreasing ��step-down�� regimen group. The PASI 50 response rates at 12 weeks were 72.7% and 85.
7% for the step-up and step-down regimens, respectively, but this difference was not statistically significant. Instead, a PASI improvement of 75% or more (PASI 75) at 12 weeks was significantly higher with the step-down regimen as compared to the other regimen (75.0% versus 51.5%). The mean time to reach PASI 75 in the step-down regimen was significantly shorter than that in the increasing dose regimen (5.8 weeks versus 7.8 weeks). As with other pruritic skin diseases, the relief of pruritus with CsA is generally marked and rapid, especially when higher doses are used [5, 22]. Pruritus is often complained by psoriasis patients and sometimes reported as unbearable, although it has been underestimated for a long time.
This symptom should not be neglected because it can be a source of psychological distress and in turn may worsen the skin lesions through the ��Koebnerization�� induced by scratching. Clinical response is coupled to a significant improvement in quality of life parameters [23]. 2.2. Novel Findings: Low Dosages, Fixed Cilengitide Dose, and Preprandial IntakeAlthough the therapeutic range of CsA is described to correspond to 2.5�C5mg/kg/day, with 2.5mg/kg/day reported as the optimal starting dose in most cases, it is established that lower doses may be also effective, with satisfactory effects attainable at least in a subset of psoriatic subjects [11]. A dosage of 1.25mg/kg/day CsA has been found to be superior to placebo [18].
No related posts.