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• W2015202274 abstract "In the abstract of their report entitled “Long-term Low-dose Cyclosporine Therapy for Severe Psoriasis: Effects on Renal Function and Structure” (J Am Acad Dermatol 1996;35:710-9) Lowe and colleagues conclude: “Older patients experience cyclosporine-induced hypertension and changes in renal function and structure more frequently than do younger patients.” This conclusion appears to be at odds with the data presented in table format within their report. Tables II and III demonstrate a similar decrease in mean glomerular filtration rate (GFR) over time for patients younger than 45 years of age as well as for patients older than 45 years of age, both at 2.5 years (16% vs 14% decrease) and at 3.5 years (25% vs 22% decrease). In their “Results” section, the authors acknowledge that “these findings support a drug effect and not an age-related decrease in renal function.” (p. 714) A difference was shown between younger and older patients with respect to percent rise in serum creatinine level at 2.5 years (3% vs 26%) and at 3.5 years (4% vs 33%). A change from 1.0 mg/dl at baseline to 1.3 mg/dl at 2.5 years and 1.4 mg/dl at 3.5 years represents a 30% and 40% increase in serum creatinine, respectively. In addition, although the baseline serum creatinine level was similar within both groups (1.0 vs 0.98 mg/dl), both muscle mass and GFR are usually lower in older patients. In this series, the mean GFR for patients younger than 45 years was 109 ml/min, whereas the mean GFR for patients older than 45 years was 93.8 ml/min. Thus a similar decrease in GFR was seen within both age groups with a higher percentage increase in serum creatinine among the older age group, as would be expected. Renal biopsies were performed on 14 patients at 2.5 years and again at 3.5 years on 12 patients. As shown in Table IV, four of six patients younger than 45 years (67%) and five of six patients older than 45 years (83%) had progressive renal changes from cyclosporine. Thus the conclusion that changes in renal structure occur more frequently among older patients is based on a group difference of one patient. Table V showed worsening of all but one of the renal biopsy indices over the duration of cyclosporine treatment, although statistical significance was achieved for quantitative interstitial fibrosis and the chronicity index (a composite score of other indices). Given the overall trend toward worsening, especially with respect to the composite score, it appears likely that similar structural changes were observed for individual patients within both age groups. In fact, the authors note a correlation between the renal biopsy changes, the decrease in mean GFR, and the increase in serum creatinine level within the “Results” section of the article. Thus a group difference of one patient is probably not clinically important. Lowe and colleagues suggest the need for a long-term multicenter study with renal biopsies performed before and after treatment, and we agree. Until such data are available, it seems premature to conclude that changes in renal function and structure caused by long-term low-dose cyclosporine therapy develop in older patients more frequently than in younger patients." @default.
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• W2015202274 title "Long-term low-dose cyclosporine therapy for psoriasis" @default.
• W2015202274 doi "https://doi.org/10.1016/s0190-9622(97)70204-4" @default.
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