Systematic review of comparative efficacy and tolerability of calcipotriolin treating chronic plaque psoriasis

Objectives To evaluate the comparative efficacy and tolerability of topical calcipotriol in the treatment of mild to moderate chronic plaque psoriasis . Design Quantitative systematic review of randomised controlled trials. Subjects 6038 patients with plaque psoriasis reported in 37 trials. Main outcome measures Mean difference in percentage change in scores on pso riasis area and severity index, and response rate ratios for both patients' and investigators' overall assessments of marked improvement or better. Ad verse effects were estimated with the rate ratio, rate difference, and numb er needed to treat. Results Calcipotriol was at least as effective as potent topical corticoste roids, calcitriol iol, short contact dithranol, tacalcitol, coal tar,and co mbined coal tar 5%, allantoin 2%, and hydrocortisone 0.5%. Calcipotriol cau sed significantly more skin irritation than potent topical corticosteroids (number needed to treat to harm for irritation 10, 95% confidence interval 6 to 34). Calcipotriol monotherapy also caused more irritation than calcipo triol combined with a potent topical corticosteroid (6, 4 to 8). However, t he number needed to treat for dithranol to produce lesional or perilesional irritation was 4 (3 to 5). On average, treating 23 patients with short con tact dithranol led to one more patient dropping out of treatment owing to a dverse effects than if they were treated with calcipotriol. Conclusions Calcipotriol is an effective treatment for mild to moderate chr onic plaque psoriasis, more so than calcitriol, tacalcitol, coal tar,and sh ort contact dithranol. Only potent topical corticosteroids seem to have com parable efficacy at eight weeks. Although calcipotriol caused more skin irr itation than topical corticosteroids this has to be balanced against the po tential long term effects of corticosteroids, Skin irritation rarely led to withdrawal of calcipotriol treatment Longer term comparative trials of cal cipotriol versus dithranol and topical corticosteroids are needed to see wh ether these short term benefits are mirrored by long term outcomes such as duration of remission and improvement in quality of life.