P092 Role of ciclosporin as adjunctive therapy in severe morphoea

Abstract Morphoea is a rare autoimmune disorder that affects the skin and underlying tissues, presenting in subtypes such as plaque, linear, generalized and pansclerotic morphoea. Treatment options are limited. Data on the efficacy of ciclosporin in managing the condition are sparse. This observational study aimed to assess the efficacy and tolerability of ciclosporin in adult patients with morphoea. In this cross-sectional study, 21 adult patients with clinically confirmed morphoea were reviewed over a 12-year period (2011–2023) from a tertiary morphoea service. Patient demographics, disease severity using the Localized Scleroderma Assessment Tool (LoSCAT), Physician’s Global Assessment, immune profiles, treatment details and adverse effects were recorded. Clinical outcomes were categorized as improved, stable or progressive, and treatment responses were assessed at regular intervals up to 1 year. The cohort included 21 patients, with a female predominance (81%). The median age at presentation was 50 years [interquartile range (IQR) 31–63], with a median age of disease onset of 49 years (IQR 21.5–60). Ciclosporin was initiated at a median dose of 1.9 mg kg−1 (IQR 1.4–2.3). One-third of patients (33%, n = 7) responded to treatment as early as 6 weeks, with 48% of patients demonstrating clinical improvement at 1 year. Ciclosporin was added to the background systemic therapy in patients who were progressing despite or intolerant of standard therapy. In 81% of patients addition of ciclosporin achieved stability or improvement of disease. Adverse effects were predominantly mild, with hypertension and muscle pain being the most frequently reported. Remission was documented in 52%. Ciclosporin demonstrated efficacy as an adjunctive therapy to achieve a rapid clinical improvement in morphoea, with responses noted as early as 6 weeks in some. The treatment is generally well tolerated, with mild adverse effects, but most patients remained on standard systemic therapies for long-term disease management. This study provides evidence for ciclosporin as a viable therapeutic option in recalcitrant morphoea, particularly when other systemic treatments are ineffective. Further research with larger cohorts and longer follow-up is warranted to better define the role of ciclosporin in treatment algorithms for this challenging condition.