BACKGROUND:Oral dexamethasone mini pulse (OMP) is an established treatment modality for active vitiligo. Cyclosporine may have therapeutic role in active vitiligo but current evidence supporting its role is scarce. OBJECTIVES: To compare the efficacy and safety of oral cyclosporine with OMP in patients of active vitiligo. PATIENTS AND METHODS: Fifty patients with active vitiligo were randomized into two groups of 25 patients. Group 1 was treated with OMP (2.5 mg dexamethasone) on two consecutive days/week for 4 months while group 2 was treated with cyclosporine (3 mg/kg/day) for 4 months. Laboratory monitoring was performed as per the prevalent protocol. The patients were followed up for another 2 months after stopping treatment. Arrest of disease progression (ADP) was defined as change of VIDA from 4+ to 3+ (time elapsed since last disease activity being more than 6 weeks upto 3 months) during the study period (6 months). ADP was attained in 21 patients in group 1 and 22 patients in group 2 (84% vs. 88%, P = 1.00) at the end of 6 months. RESULTS: However, mean time to achieve ADP was significantly lower in group 2 as compared to group 1 [10.92(4.12) weeks vs. 13.90(3.92) weeks, P = 0.01]. Extent of repigmentation, improvement in patient assessment score, vitiligo quality of life and clinical markers of disease activity were marginal and comparable in both groups. CONCLUSION:Cyclosporine leads to earlier disease stabilization in active vitiligo as compared to OMP. Although considered a rescue drug in dermatology, low dose cyclosporine can be an effective therapeutic alternative in vitiligo patients. This article is protected by copyright. All rights reserved.
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BACKGROUND: Oral dexamethasone mini pulse (OMP) is an established treatment modality for active vitiligo. Cyclosporine may have therapeutic role in active vitiligo but current evidence supporting its role is scarce. OBJECTIVES: To compare the efficacy and safety of oral cyclosporine with OMP in patients of active vitiligo. PATIENTS AND METHODS: Fifty patients with active vitiligo were randomized into two groups of 25 patients. Group 1 was treated with OMP (2.5 mg dexamethasone) on two consecutive days/week for 4 months while group 2 was treated with cyclosporine (3 mg/kg/day) for 4 months. Laboratory monitoring was performed as per the prevalent protocol. The patients were followed up for another 2 months after stopping treatment. Arrest of disease progression (ADP) was defined as change of VIDA from 4+ to 3+ (time elapsed since last disease activity being more than 6 weeks upto 3 months) during the study period (6 months). ADP was attained in 21 patients in group 1 and 22 patients in group 2 (84% vs. 88%, P = 1.00) at the end of 6 months. RESULTS: However, mean time to achieve ADP was significantly lower in group 2 as compared to group 1 [10.92(4.12) weeks vs. 13.90(3.92) weeks, P = 0.01]. Extent of repigmentation, improvement in patient assessment score, vitiligo quality of life and clinical markers of disease activity were marginal and comparable in both groups. CONCLUSION:Cyclosporine leads to earlier disease stabilization in active vitiligo as compared to OMP. Although considered a rescue drug in dermatology, low dose cyclosporine can be an effective therapeutic alternative in vitiligo patients. This article is protected by copyright. All rights reserved.
Authors: N van Geel; L Depaepe; V Vandaele; L Mertens; J Van Causenbroeck; S De Schepper; L Van Coile; A Van Reempts; A-S De Vos; J Papeleu; I Hoorens; D Mertens; A Wolkerstorfer; J E Lommerts; R Speeckaert Journal: J Eur Acad Dermatol Venereol Date: 2022-04-29 Impact factor: 9.228