Cautious about Cyclosporine
from Jacqui

Hi.  I live in Northern Ireland and am concerned about my dermatologist wanting to put me on cyclosporine.  I have an abnormal liver which they keep testing.  I don’t know why this is because I haven’t drank for years.  They say it’s because of using Paracetamol for over 20 years for bad pain.  I also have high blood pressure and cholesterol of 8.  I was wondering what the success rate for psoriasis remission is with this drug and should I try it? 

I would also really appreciate if it people could mail me as I am housebound due to very severe PA for which one consultant wants me to take methotrexate.  I would be grateful for any advice you guys could give me and would love to hear from people in Northern Ireland , too.  –Jacqui ([email protected])

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Ed’s Response:  You are right to be concerned about cyclosporine with your liver situation.  As I write this I’m dosing down to conclude another 10 months on cyclo and the drug has elevated my blood pressure, caused significant edema in my legs, greatly accelerated body hair growth (which can be an unimaginable irritation!) and required frequent blood work-ups to check for liver and kidney anomalies.  Having said all that, cyclosporine is the one and only drug I’ve taken that can — though it didn’t this time — completely eliminate any visible psoriasis on me. 

Cyclo isn’t pitched as a psoriatic arthritis (PA) drug — like methotrexate — but for some of us — including me — it does reduce the pain of PA while it dramatically improves skin P.  I don’t typically notice the reduction in pain while I’m on the drug, but as soon as I dose-down (to wean myself off the drug) and when I’m in the inevitable re-bound the increase in PA pain certainly suggests that it had been doing something to keep it down. 

If your more severe condition is PA, Jacqui, I’m surprised cyclosporine would be considered in lieu of methotrexate (MTX), because MTX is the most prescribed systemic for the treatment of severe PA.  However, MTX can be even more damaging to the liver than cyclo (which seems to hit kidneys harder).  Since you already have drug-related liver problems, it does not surprise me that at least some doctors discourage your use of MTX. 

Jacqui, I hate to say things that can’t be acted upon, but perhaps you could inquire in Northern Ireland about biologic trials.  Two biologics available in the U.S. are both known to improve arthritis and psoriasis symptoms: etanercept (marketed here as Enbrel) and infliximab (marketed here as Remicade and not yet approved for psoriasis).  Both of these are proving to be very helpful for a lot of people.  Even if you could find trials in your area, these might help you.

In the meantime, if MTX or cyclosporine are in your future, you must know that tens of thousands of us have used these drugs safely by carefully following dosing instructions and maintaining our regularly scheduled lab tests and follow-up examinations.  Your doctors know your risks.  The benefits can be powerful.  Before I tried either of these drugs I was afraid of them both (my liver wasn’t in very good shape, either).  But when I came close to becoming housebound because of PA I finally said “okay” to methotrexate and have since used the drug on-and-off continually.  It almost completely negates my psoriatic arthritis pain.  I don’t even have to take painkillers while I’m taking methotrexate. 

Stay in touch, Jacqui.  We want to know how you are doing.  -Ed

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