Safety and efficacy of oral calcitriol (1, 25 -dihydroxyvitamin D₃ ) for the treatment of psoriasis

Abstract

Plaque-type psoriasis has been successfully treated with oral calcitriol, but there has been no long-term follow-up on the safety and efficacy of this calciotropic hormone for psoriasis. In a single centre study, patients were enrolled in an open trial to evaluate the efficacy and safety of oral calcitriol for psoriasis. Of the 85 patients who received oral calcitriol, 88.0% had some improvement in their disease; 26.5, 36.2 and 25.3%, had complete, moderate and slight improvement in their disease, respectively. The mean baseline psoriasis area severity index score (PASI) of 18.4 +/- 1.0 was reduced to 9.7 +/- 0.8 and 7.8 +/- 1.3 after 6 and 24 months on oral calcitriol therapy. Serum calcium concentrations and 24 h urinary calcium excretion increased by 3.9% and 148.2%, respectively, but were not outside the normal range. Bone mineral density remained unchanged. The clearance of creatinine decreased by 13.4% from baseline during the first 6 months of treatment, and thereafter, remained unchanged after 3 years of follow up. An evaluation of creatinine, inulin and paraaminohypurate (PAH) clearance was performed in eight patients. After 6 months on oral calcitriol, there was a 22.5% decline in creatinine clearance but no significant changes were observed in either inulin or PAH clearance, suggesting that calcitriol alters creatinine metabolism or secretion but does not affect renal function. Oral calcitriol is effective and safe for the treatment of psoriasis.

A rise in plasma creatinine that is not a sign of renal failure: which drugs can be responsible?

“…Free or ionized calcium was not measured, which means that hypercalcaemia as a cause cannot be completely excluded. However, in two studies GFR (inulin clearance) was concomitantly determined and appeared to be unchanged [60,61]. The mechanisms by which vitamin D enhances plasma creatinine concentration are unclear, but might be decreased tubular secretion and/or enhanced creatinine production.…”

UVB and Vitamin D in Psoriasis

“…A number of small trials show the efficacy and safety of vitamin D metabolites in the treatment of psoriasis and psoriatic arthritis (27)(28)(29). Systemic calcitriol treatment had an immunomodulatory effect manifested by a short-term temporary decrease in type 1 immune responses and a decrease in disease activity in patients with psoriatic arthropathy (27).…”

Analysis of the vitamin D system in basal cell carcinomas (BCCs)

“…[10][11][12] Clinically, the antiproliferative and prodifferentiating effects of vitamin D analogs are used successfully in the treatment of the hyperproliferative skin disease psoriasis. [13][14][15] Combination of 1,25-dihydroxyvitamin D 3 and isotretinoin was reported to be effective in the chemotherapy of precancerous and cancerous skin lesions, including squamous and basal cell carcinomas (BCC). 16 Additionally, it has been shown that VDR ablation sensitizes skin to chemically induced carcinogenesis.…”