Benefit of Progressively Increasing Doses during the Initial Treatment with Acitretin in Psoriasis

Abstract

The purpose of this double-blind study was to compare the therapeutic effects of a low initial dosage of acitretin, increased at 2-week intervals (group 1:10, 30, 50 mg/day) with a high initial dosage decreased at similar intervals (group 3: 50, 30, 10 mg/day) and with a constant dosage (group 2: 30 mg/day) in 66 patients (47 men and 19 women) with severe psoriasis. At the end of the double-blind phase the mean percent improvement calculated by the Psoriasis Area and Severity Index score, was as follows: 62.7% in group 1, 55.9% in group 2 and 67.1% in group 3.The double-blind phase of 6 weeks was followed by an open phase of 6 weeks, during which the patients were treated either with 10, 30 or 50 mg/day, according to the therapeutic response. At the end of treatment (12 weeks), a mean improvement of more than 80% was obtained in all three groups. Hypervitaminosis A signs and symptoms were observed in all patients. The frequency and severity of these adverse reactions were shown to be dose-dependent. This study shows that a low dose progressively increased is advisable because of similar activity and better acceptability.

British Association of Dermatologists guidelines on the efficacy and use of acitretin in dermatology

“…20,94 Gradual dose escalation has been shown to be the most effective approach and allows gradual onset of 'tolerance' to side-effects. 94,132 The initial daily dose, 25 mg or 30 mg for 2-4 weeks, may give satisfactory therapeutic results. The maintenance dose must be based on clinical efficacy and tolerability.…”

Low-dose Acitretin in Treatment of Plaque-type Psoriasis: Descriptive Study of Efficacy and Safety

“…Considering the chronic course of psoriasis, low-dose acitretin (between 25 and 35 mg/day) is preferable as it reduces the risk of adverse events without sacrificing long-term effectiveness (14)(15)(16). Some authors suggest starting treatment with a lower daily dosage (between 10 and 25 mg) followed by a gradual dose escalation (9,(17)(18)(19).…”

Current and Future Oral Systemic Therapies for Psoriasis

“…51 In another study, after 12 weeks of treatment with acitretin, the mean PASI improvement was 70% to 75%. 52 Clearance or marked improvement was achieved by 41% of 59 subjects treated with 20 mg/d acitretin, with dose increases of 10 mg every 2 weeks up to a final dose of 70 mg; however, 36% of subjects dropped out of the study, mostly because of retinoid-related adverse events. 53 A recent review of acitretin serves as an update to the 2009 AAD guidelines.…”