Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis

British Medical Journal,  April 8, 2000  by Darren M Ashcroft,  Alain Li Wan Po,  Hywel C Williams,  Christopher E M Griffiths

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Once daily calcipotriol--Two trials compared twice daily and once daily regimens with calcipotriol in 480 patients.[w22 w37] Efficacy based on the percentage change in psoriasis area and severity index scores showed superiority for the twice daily regimen; the pooled mean difference in effect was 5.5% (1.2% to 9.8%).

Calcitriol and calcipotriol had a greater effect over twice daily topical calcitriol (figure). At six and eight weeks in one parallel trial, the mean difference in percentage change in psoriasis area and severity index scores was 34.2% (9.8% to 58.7%) and 50.9% (30.6% to 71.2%) respectively.[w24]

Coal tar--One trial showed that at six weeks topical calcipotriol was superior to coal tar.[w26] The results were consistent with those obtained using the patients' and the investigators' overall assessments of at least marked improvement; the corresponding rate ratios were 5.5 (1.3 to 22.7) and 4.3 (1.4 to 13.7).

Coal tar 5%, allantoin 2%, and hydrocortisone 0.50%--From the investigators' overall assessment in a trial of 122 patients the rate ratio for marked improvement or better was 1.5 (1.1 to 2.1), indicating that calcipotriol was significantly better than coal tar 5%, allantoin 2%, and hydrocortisone 0.5% (fig B on website).

"Short contact" dithranol--Calcipotriol was significantly more effective than short contact dithranol on the basis of all three response measures. At eight and 12 weeks the rate ratios for marked improvement or better in the patients' overall assessment were 1.5 (1.3 to 1.7) and 1.3 (1.0 to 1.6) and for the investigators' overall assessment were 1.6 (1.4 to 1.8) and 1.2 (1.0 to 1.5).

Tacalcitol--From the patients' and investigators' overall assessments in one trial, twice daily calcipotriol was more effective than once daily tacalcitol at eight weeks of treatment[w32]; both rate ratios were 1.4 (1.1 to 1.8).

Ultraviolet B phototherapy and calcipotriol--No statistical difference was found between the treatments except for scores on the psoriasis area and severity index (figure).

Withdrawal from treatment

Significantly more patients withdrew from placebo compared with calcipotriol (table B on website). Surprisingly, more patients withdrew from treatment with very potent topical corticosteroids. Most patients (32 of 48) dropped out as a result of resolution of their psoriasis. In contrast, short contact dithranol resulted in a significantly higher overall withdrawal rate but also a higher withdrawal rate due to adverse effects of treatment.

Sensitivity analysis (95% confidence intervals) of type of patients treated in placebo controlled trials at eight weeks

Patients    Mean difference in % change in
treated    psoriasis area and severity index

Adults            44.1 (27.8 to 60.4)
Children         10.6 (-10.1 to 31.3)
Overall           28.0 (-4.8 to 60.8)

             Rate ratio of overall assessment
Patients
treated        Patients        Investigators

Adults     2.9 (1.7 to 5.0)   4.7 (3.5 to 6.4)
Children   0.8 (0.5 to 1.4)   1.1 (0.7 to 1.8)
Overall    1.6 (0.5 to 5.3)   3.6 (1.7 to 7.6)