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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Potential sources of heterogeneity in the results may include the formulation, choice of topical corticosteroid, and patient population (children or adults). Unfortunately, there were too few studies for further exploring these issues. However, calcipotriol seemed more effective in adults than in children, an observation that needs further confirmation.

Future trials should examine efficacy over a much longer period than six to eight weeks (for example, up to six months) to capture the relapsing and remitting nature of the disease. Adverse effects may also not be detected during the short durations of the published randomised controlled trials. Number needed to treat values for adverse reactions were based on data pooled from trials lasting four to 12 weeks. Caution in their interpretation is obviously required.

Conclusions

Pooled data from randomised controlled trials show that calcipotriol is an effective and well tolerated treatment for mild to moderate chronic plaque psoriasis. Although skin irritation is comparatively common, this rarely requires withdrawal of calcipotriol treatment. Potent topical corticosteroids have also emerged as equally effective agents when assessed at eight weeks, with less short term side effects than calcipotriol. Future trials should focus on examining the risk to benefit ratios from combined regimens of calcipotriol with other antipsoriatic agents and include information on quality of life and disease remission.

We thank the following for information and unpublished data: Dr N K Veien, Professor J P Ortonne, Dr J F Bourke, Professor G Landi, Dr L Cresti and Dr D Crippa (Schering), Dr S Lovati, and Dr L Naldi; Mrs I Muller (Leo Pharmaceutical Products); Mr Q D Clarke, Mr P Menday, and Ms C Michell (Leo Pharmaceuticals), Dr A Herxheimer, Dr T F Poyner, Dr W Y Zhang, Dr R T Plott, and Dr S F Levy (Dermik Laboratories), and Dr S B Siskin (Bristol-Myers Squibb).

Contributors: DMA and ALWP designed the study, conducted the literature searches, abstracted the data, analysed the results, and wrote the paper. HCW and CEMG helped write the paper and provided clinical interpretation of the included trials and the results. ALWP and DMA will act as guarantors for the paper.

Funding: A research grant from Boots Healthcare.

Competing interests: DMA is a recipient of a research grant from E Merck Pharmaceuticals who initially marketed tacalcitol in the United Kingdom. ALWP is the recipient of funding for studentships from Leo Pharmaceuticals (manufacturer of calcipotriol) and Merck Lipha. CEMG's department is the beneficiary of research grants from both Leo and E Merck. CEMG has also acted as a consultant to both companies on an ad hoc basis.

What is already known on this topic

Calcipotriol has become one of the most commonly prescribed antipsoriatic treatments, but until now there has been any systematic assessment of its usefulness compared with other topical agents for psoriasis

What this study adds

Calcipotriol is a useful drug for treating mild to moderate psoriasis. It seems to be more effective than calcitriol, tacalcitrol, coal tar, and short contact dithranol but it is associated with a high frequency of skin irritation