Analysis of risk factors increasing serum creatinine level in patients with psoriasis treated with cyclosporin A

Background: Cyclosporin A (CsA) is an immune modulating agent in treating psoriasis. Considering its nephrotoxicity, however, serum creatinine (SCr) levels should be monitored carefully. Objectives: The objective of this study is to evaluate the safety of CsA and risk factors associated with a renal impairment in treatment of psoriasis with CsA. Methods: The 284 patients with psoriasis treated with CsA between January 2011 and December 2016 were analyzed. Results: The median duration of treatment was 10 weeks (interquartile range: 4-21) and the mean dose of CsA was 3.14±0.38 mg/kg/day. Although there was a significant increase of SCr levels after CsA treatment (P = 0.01), the overall change was largely reversible on cessation of the drug. More than 25% increase of SCr above baseline was reported in 17 patients (6.0%). Comparing those with increased SCr to the others, there was no significant difference in sex, body mass index, psoriasis area and severity index, disease duration, mean dose of CsA except the age (P = 0.005). Patients older than 60 years resulted at higher risk for a rise in SCr levels when compared with younger patients (P < 0.001). The treatment duration more than a year and hypertension also found to be significantly related to the SCr elevation. Conclusion: Careful SCr monitoring is needed in patients who have factors that might increase the SCr levels, such as old age, treatment duration more than a year and the hypertension.