Effectiveness and safety of oral tacrolimus in refractory chronic urticaria

Another calcineurin inhibitor, tacrolimus, has also been used in CU and has shown some promise as an alternative agent.4 Side effect profiles differ between calcineurin inhibitors, and for some patients, the tacrolimus side effect profile may be preferred. Because CU frequently affects women, hirsutism associated with cyclosporine may be a particularly undesirable adverse effect. Twenty-three subjects experienced adverse effects while on tacrolimus including gastrointestinal symptoms (8), hypertension (3), elevated serum creatinine (4), headache (4), paresthesia (3), lower extremity edema (3), and other effects (5) including tremors, joint pain, irritability, sleeplessness, memory and speech problems, hair loss, myalgia, pain sensation in skin, possible elevation glycated hemoglobin (unknown baseline), vision changes, and paresthesia. Subjects N = 36 Mean age at the start of tacrolimus 41.6 (27-67) y Female patients 30/36 (91%) Mean duration of current CU symptoms before tacrolimus∗ 5.1 y Patients on chronic oral steroid before tacrolimus∗ 17/36 (47%) Mean daily prednisone dose (or equivalent) before tacrolimus initiation∗ 17.2 mg Failed at least 1 alternative medication 31/36 (86%) Montelukast 16 (44%) Dapsone 20 (56%) Sulfasalazine 1 (39%) Hydroxychloroquine 10 (28%) Colchicine 7 (19%) Omalizumab 4 (11%) Cyclosporine 1 (3%) Mycophenolate 2 (6%) Levothyroxine 3 (8%) Failed 2 or more alternative medications 23 (64%) Table I Baseline patient characteristics before tacrolimus