Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: a randomized, controlled, investigator-blinded clinical trial

• Published in: The American journal of clinical nutrition Vol. 88; no. 5; pp. 1242 - 1247
• Main Authors: Gisondi, Paolo, Del Giglio, Micol, Di Francesco, Vincenzo, Zamboni, Mauro, Girolomoni, Giampiero
• Format: Journal Article
• Language: English
• Published: Bethesda, MD American Society for Nutrition 01.11.2008; American Society for Clinical Nutrition; American Society for Clinical Nutrition, Inc
• Subjects: Biological and medical sciences; body mass index; chronic diseases; Clinical trials; Combined Modality Therapy; Cyclosporine - therapeutic use; cyclosporins; Dermatologic Agents - therapeutic use; Diet; Diet, Reducing; dose response; Drug therapy; Effectiveness studies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Life Style; low calorie diet; Male; Middle Aged; Obesity; Obesity - complications; Obesity - diet therapy; obesity-related diseases; patients; plaque psoriasis; Psoriasis; Psoriasis - drug therapy; Psoriasis - etiology; Psoriasis - pathology; randomized clinical trials; Severity of Illness Index; Treatment Outcome; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Weight control; weight loss; Weight Loss - physiology; Human; Obesity; Therapy; Skin disease; Chronic; Psoriasis; Low dose; Nutrition disorder; Weight loss; Clinical trial; Severe; Nutritional status
• ISSN: 0002-9165; 1938-3207
• DOI: 10.3945/ajcn.2008.26427

BACKGROUND: Chronic plaque psoriasis is frequently associated with obesity. The effect of a hypoenergetic diet on psoriasis has not been investigated. OBJECTIVE: The objective was to investigate whether moderate weight loss (ie, 5-10% of body weight) increases the therapeutic response to a low dose of cyclosporine in obese patients with moderate-to-severe chronic plaque psoriasis. DESIGN: A 24-wk randomized, controlled, investigator-blinded clinical trial was conducted in 61 patients. The efficacy of 2.5 mg · kg⁻¹d⁻¹ cyclosporine combined with a low-calorie diet (intervention group) was compared with cyclosporine alone (control group) in obese patients [body mass index (in kg/m²) > 30] with moderate-to-severe psoriasis. The primary endpoint was an improvement from baseline of greater-than-or-equal75% in the Psoriasis Area and Severity Index (PASI 75 response) at week 24. RESULTS: At week 24, the mean (± SD) reduction in body weight was 7.0% ± 3.5 in the intervention group and was 0.2% ± 0.9 in the control group (P < 0.001). The PASI 75 response was achieved by 20 of 30 patients (66.7%) treated with cyclosporine plus a low-calorie diet and by 9 of 31 (29.0%) patients treated with cyclosporine alone (P < 0.001). Four patients (13.3%) from the intervention group and 14 (45.1%) from the control group withdrew prematurely from the study (P < 0.001). CONCLUSIONS: Obese patients with moderate-to-severe psoriasis increase their response to low-dose cyclosporine if a calorie-controlled diet is included in the treatment regimen. Lifestyle modifications, including a low-calorie diet, may supplement the pharmacologic treatment of obese psoriasis patients. This trial was registered at clinicaltrials.gov as NCT00512187.