Cyclosporin A pharmacokinetics in a patient with psoriasis and obesity, presenting with high levels of low-destiny lipoprotein

Cyclosporin A (CyA), an immunosuppressant, is now frequently used for the treatment of psoriasis and its usefulness is widely known. This letter reports on an obese and hyperlipemic patient with psoriasis, where the metabolism of CyA was successfully normalized and efficacy was increased, followed by an improvement in the clinical symptoms when hyperlipemia was improved. The patient was a 51-year-old Japanese woman with psoriasis vulgaris. In spite of treatment with a steroid for external use, eruption worsened. Oral administration of CyA at a daily dose of 2 mg/kg, which was started thereafter, also led to no improvement in eruption. Hyperlipemia type IIa was diagnosed on the basis of blood analysis. When fluvastatin (FV) was combined with CyA, a remarkable improvement in eruption was found. Lipid metabolism was therefore considered to be involved in the effect and pharmacokinetics of CyA. To study the reasons why a high-trough level was reached after administration of CyA at a dosage of 2 mg/kg/day and why eruption was remarkably improved after oral administration of FV, the pharmacokinetics of CyA were also measured. The patient was orally administered CyA (2 mg/kg) after breakfast and the CyA monoclonal whole blood values were determined; the radioimmunoassay (RIA) concentration was measured 1, 2, (3), 4, 6, 12, and 24 h later [6 (7) times in total]. In addition, the blood was sampled in the morning after fasting to determine the levels of triglyceride (TG), total cholesterol (T-chol), low-density lipoprotein (LDL), and so forth. The levels of the serum lipids before oral administration of FV were high, that is, T-chol of 270 mg/dl and LDL-chol of 204 mg/dl. The pharmacokinetics of CyA showed a high-trough level of 300 ng/dl and the blood CyA concentration did not decrease even 15 h after oral administration (24 h after oral administration of CyA, the blood CyA concentration was also abnormally high, at 270 ng/ml).