Combination Regimens of Topical Calcipotriene in Chronic Plaque Psoriasis

Abstract

To examine the efficacy and tolerability of calcipotriene combined with phototherapy or systemic therapies compared with monotherapy for the treatment of chronic plaque psoriasis.Design: Quantitative systematic review of 11 randomized controlled trials involving a total of 756 patients with plaque psoriasis.Main Outcome Measures: Rate ratios (RRs) for marked improvement or clearance in patient and investigator overall assessments of response; mean difference in percentage change in Psoriasis Area and Severity Index; and RRs for clearance in patient and investigator overall assessments of response. Adverse effects were estimated with the RR and the rate difference in terms of withdrawal rate, proportion of patients experiencing adverse events, and proportion of patients with cutaneous and noncutaneous adverse effects.Results: Antipsoriatic effects of acitretin, cyclosporine, and psoralen-UV-A phototherapy were enhanced with the addition of topical calcipotriene using the Psoriasis Area and Severity Index as the outcome, but this is not translated into an increase in the number of patients who achieve at least marked improvement. At the end of treatment, the RRs for marked improvement or clearance in patient assessments were as follows: calcipotriene plus acitretin vs acitretin alone (12 weeks), 1.4 (95% confidence interval [CI], 1.0-1.9); calcipotriene plus cyclo-

Combination therapy to treat moderate to severe psoriasis

“…Concomitant acitretin and calcipotriene increase therapeutic efficacy and reduce acetretin dosage. In a meta-analysis of studies of calcipotriene combination therapy, Ashcroft et al 48 found that this acitretin-calcipotriene regimen was more likely to achieve marked improvement than was acitretin alone. Van de Kerkhof et al 78 found that clearance was achieved with significantly lower cumulative dosages of acitretin in patients receiving acitretin and calcipotriene than in those receiving acitretin and placebo (P ϭ .006).…”

The Frequent Use of Oral Retinoids in Combination with Other Treatments for Psoriasis: A Retrospective Analysis

“…7,14 Combination regimens that include oral retinoids are attractive because the addition of a second or even third agent augments efficacy. 15,16 While minor adverse effects may be common at high doses, these may be managed by dose reduction as part of a combination regimen. Unfortunately, we do not have data on doses used when a medication was used as monotherapy versus in a combination regimen.…”

Topical Calcipotriol plus Oral Fumaric Acid Is More Effective and Faster Acting than Oral Fumaric Acid Monotherapy in the Treatment of Severe Chronic Plaque Psoriasis vulgaris

“…Calcipotriol has been previously shown to be well tolerated and efficacious in combination with numerous other psoriatic treatments, including topical therapies [13], phototherapy [15, 16]and systemic therapy [13, 14]. A study was carried out to investigate the addition of calcipotriol ointment (50 µg/g) to systemic retinoid acitretin therapy in psoriasis [14].…”

“…Calcipotriol has been demonstrated to be equivalent to or more effective than dithranol [8], coal tar [9]and at least as effective as steroids [10, 11]. It is effective in the long term [12]and has been successfully used in combination with systemic treatments [13, 14]and, as well as other vitamin D 3 derivatives, with phototherapy [15, 16, 17]. Calcipotriol is well tolerated, even in children [18], with no effect on hepatic or renal function or calcium haemostasis [19].…”