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Topical long‐term therapy of psoriasis with vitamin D 3 analogues, corticosteroids and their two compound formulations: position paper on evidence and use in daily practice
Author(s) -
Augustin Matthias,
Mrowietz Ulrich,
Bonnekoh Bernd,
Rosenbach Thomas,
Thaçi Diamant,
Reusch Michael,
Ardabili Michael,
Reich Kristian
Publication year - 2014
Publication title -
jddg: journal der deutschen dermatologischen gesellschaft
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 60
eISSN - 1610-0387
pISSN - 1610-0379
DOI - 10.1111/ddg.12396
Subject(s) - medicine , psoriasis , betamethasone dipropionate , tolerability , combination therapy , clinical trial , dermatology , dosing , acitretin , vitamin d and neurology , pharmacology , adverse effect
Summary Background Current data from daily practice show that vitamin D 3 analogues, corticosteroids and their fixed combination products are used heterogeneously for topical long‐term treatment of psoriasis. Aim To evaluate scientific evidence about topical long‐term therapy with vitamin D 3 analogues, corticosteroids and their two‐compound‐products in psoriasis vulgaris and scalp psoriasis and to develop daily practice recommendations. Methods Systematic literature review via PubMed® and Embase® and informal expert consensus. Results The search strategy identified 21 relevant clinical trials. Best evidence regarding topical long term treatment was available for the two‐compound‐formulation containing calcipotriene and betamethasone. In a comparative trial in psoriasis vulgaris the two‐compound‐formulation showed superior tolerability and cost effectiveness compared to monotherapy. In scalp psoriasis the two‐compound‐gel was superior compared to calcipotriene monotherapy. Standardized and simplified treatment application modes resulted in a better clinical outcome comparing to on‐demand therapies. Daily practice recommendations Patients should be proactively involved in the choice of treatment, formulation and mode of application. Besides long‐term treatment with the two‐compound‐formulation other treatment regimens including calcipotriene monotherapy can also be considered. Due to a favorable risk‐benefit ratio in maintenance trials and due to better cost‐effectiveness the application of two‐compound‐products once or twice a week after initial therapy is recommended.