Calcipotriol Cream Combined with Twice Weekly Broad-Band UVB Phototherapy: A Safe, Effective and UVB-Sparing Antipsoriatric Combination Treatment

Ramsay, Colin A.; Schwartz, Brian; Lowson, David; Papp, Kim; Bolduc, Alain; Gilbert, Martin

doi:10.1159/000018309

Cited by 64 publications

(46 citation statements)

References 10 publications

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“…While Kragballe [18]described no significant difference in improvement between patients treated with topical calcipotriol in conjunction with UVB and those treated with calcipotriol alone, Kokelij et al [19]showed that the combination of calcipotriol and UVB light has been superior to monotherapy with UVB light. Ramsay et al [20]reported that the addition of calcipotriol cream to broad-band UVB treatment resulted in fewer UVB exposures and a lower cumulative irradiance. However, in our study there was no significant difference regarding therapy efficacy and treatment parameters in patients treated with either UVB monotherapy or UVB + adjunctive agents.…”

Section: Discussionmentioning

confidence: 99%

Phototherapy of Psoriasis: Comparative Experience of Different Phototherapeutic Approaches

Karrer¹,

Eholzer²,

Ackermann³

et al. 2001

Dermatology

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Background: Broad-band UVB alone or in combination with different topical drugs (anthralin, calcipotriol), systemic PUVA and bath-PUVA therapy are very effective and well-established treatment modalities for psoriasis. Objective: The aim of this retrospective study was to assess which of these routinely applied phototherapeutic modalities might be most effective and safe for the treatment of plaque-type psoriasis. Methods: Patients (n = 203) with moderate to severe (pretreatment Psoriasis Area and Severity Index score between 12 and 35) chronic plaque-type psoriasis treated between 1992 and 1998 at our department with either UVB (with/without anthralin or calcipotriol; n = 97), systemic PUVA (n = 19) or bath-PUVA therapy (n = 87) were evaluated for efficacy, duration of treatment, number of treatments necessary for complete remission (CR), cumulative light dose, side effects of therapy and duration of remission after therapy. Results: No statistically significant difference comparing the efficacy of bath-PUVA (CR in 72.4%), PUVA (CR in 89.5%) and UVB phototherapy (CR in 69.1%) was found. Although the duration of therapy was significantly longer for bath-PUVA (66 ± 42 days) as compared to UVB treatment (50 ± 27 days), the mean number of treatments did not differ significantly between bath-PUVA (28 ± 12), UVB therapy (30 ± 12) and PUVA (26 ± 13). Significantly fewer side effects of phototherapy were observed with bath-PUVA (14.9%) therapy compared to UVB treatment (30.9%). Also, the duration of remission after successful therapy was significantly longer for bath-PUVA (8.4 ± 3.5 months) as compared to UVB phototherapy (5.1 ± 4.2 months). Conclusion: Bath-PUVA therapy has some advantages over UVB phototherapy in the treatment of psoriasis: fewer UV-related acute side effects and a longer period of remission after therapy. However, the choice of treatment with either UVB, bath-PUVA or systemic PUVA should also be based on a history of previous response to treatment and patient considerations, including compliance and responsibility for following the precautions to avoid potential side effects.

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Section: Discussionmentioning

confidence: 99%

Phototherapy of Psoriasis: Comparative Experience of Different Phototherapeutic Approaches

Karrer¹,

Eholzer²,

Ackermann³

et al. 2001

Dermatology

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“…Clinical data were obtained from a Canadian study comparing calcipotriol and emollient in combination with broad-band UVB phototherapy [12]. In order to adapt to Dutch treatment settings, information of costs and current clinical practice of moderate to severe psoriasis were obtained by questionnaire to Dutch dermatologists, literature research and a consensus panel.…”

Section: Design and Methodsmentioning

confidence: 99%

“…The clinical trial involving 164 patients with moderate to severe psoriasis was conducted in nine centres in Canada [12]. The clinical study tested the efficacy and safety of calcipotriol combined with twice weekly UVB sessions compared to three weekly UVB sessions plus an emollient.…”

Section: Design and Methodsmentioning

confidence: 99%

Pharmacoeconomic Evaluation of Calcipotriol (Daivonex®/Dovonex®) and UVB Phototherapy in the Treatment of Psoriasis: A Markov Model for The Netherlands

Rie

Hoop

Jönsson³

et al. 2001

Dermatology

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Background: The high prevalence and chronic nature of psoriasis leads to high costs in relation to the treatment and control of the disease. A number of clinical trials have shown that a combination therapy of calcipotriol cream (Daivonex^®/Dovonex^®, Leo Pharmaceutical Products) and ultraviolet B phototherapy (UVB) decreases the total number of UVB exposures required compared to UVB treatment alone. From a societal point of view, the addition of calcipotriol to UVB therapy could achieve cost savings due to the fewer UVB treatments needed and the reduced travelling and time off work for patients. Fewer UVB exposures may also have other beneficial effects, i.e., shortened waiting lists and less risk to patients of developing cancer or photoaging of the skin. Objective: To compare the cost-effectiveness of treating psoriatic patients in the Netherlands with calcipotriol cream used daily combined with twice weekly UVB treatments to emollient used daily combined with UVB given 3 times weekly. Methods: Based on the clinical results from a Canadian trial, a decision-analytical model was constructed to simulate treatment outcomes and estimate the costs of managing psoriatic patients in the Netherlands over a period of 20 weeks from initiation of therapy. Unit costs and details of standard treatment protocols were collected from Dutch dermatology centres in hospitals and the community for use in the model. Other therapies, such as topical corticosteroids, tar or dithranol were not investigated in this analysis. Results: The total cost of managing psoriatic patients in the Netherlands over a 20-week period is estimated as EUR 1,175.90 for those treated with calcipotriol and UVB and EUR 1,212.14 for patients treated with emollient and UVB. Thus, the former treatment, adding calcipotriol to UVB phototherapy, provides a minor cost saving of EUR 36.24 (3%) compared to the cost of UVB treatment alone. Sensitivity analyses demonstrated that these results are sensitive to changes in the cost of UVB treatment. Conclusion: Calcipotriol treatment combined with UVB phototherapy is a cost-neutral alternative to UVB phototherapy used with an emollient. The patients achieve treatment success in the same time on both treatments but the former, with calcipotriol, requires less exposure to UVB radiation. The additional drug costs from using calcipotriol are offset by savings from the fewer UVB sessions required. Essential beneficial effects for patients are less inconvenience, less risk of developing photoaging of the skin and less exposure to potentially carcinogenic radiations.

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“…Several types of combination therapies have been proposed using vitamin D derivatives [24, 25, 26, 27]. They likely influence the histometric parameters used in the present study.…”

Section: Discussionmentioning

confidence: 99%

Histometric Assessment of Psoriatic Plaques Treated by Vitamin D3 Derivatives

et al. 2003

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Background: Psoriasis is an immunogenetic disorder. Factor XIIIa+ dermal dendrocytes (DD) are part of the pathobiological changes in the plaque type of the disease. Objective: The present study aimed at comparing the effect of 3 vitamin D₃ derivatives on the epidermis, microvasculature and DD in psoriasis. Method: Twenty men suffering from chronic plaques of psoriasis on the trunk were enrolled in this study. They applied twice a day for 3 weeks calcipotriol, tacalcitol and calcitriol, each to one plaque. Another similar lesion received petrolatum as a placebo treatment. Skin biopsies were taken at entry and at completion of the 3-week treatment phase. Immunohistochemistry was performed using the lectin of Ulex europaeus and an antibody to factor XIIIa. Computerized image analysis served to measure the stratum Malpighii area, the microvasculature area and the DD numerical density in the papillary dermis. Results: At entry in the study, the 4 test sites were indistinguishable with regard to the stratum Malpighii area, the papillary microvasculature area and the papillary DD density. The 3 histometric parameters appeared correlated with each other. At completion of the 3-week treatment phase, the 3 vitamin D derivatives had decreased the size of the stratum Malpighii. In addition, calcitriol had also reduced the DD density in the papillary dermis. No other significant changes were yielded. Conclusion: As assessed by histometry, the psoriatic epidermis responded to a short treatment using the 3 vitamin D derivatives. The better result compared to the control site was achieved by calcitriol. DD appeared to be most controlled by the same drug. The microvasculature did not appear to be decreased at the 3-week time point in treatment.

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Calcipotriol Cream Combined with Twice Weekly Broad-Band UVB Phototherapy: A Safe, Effective and UVB-Sparing Antipsoriatric Combination Treatment

Cited by 64 publications

References 10 publications

Phototherapy of Psoriasis: Comparative Experience of Different Phototherapeutic Approaches

Phototherapy of Psoriasis: Comparative Experience of Different Phototherapeutic Approaches

Pharmacoeconomic Evaluation of Calcipotriol (Daivonex<sup>®</sup>/Dovonex<sup>®</sup>) and UVB Phototherapy in the Treatment of Psoriasis: A Markov Model for The Netherlands

Histometric Assessment of Psoriatic Plaques Treated by Vitamin D<sub>3</sub> Derivatives

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