Contemporary Role of Topical Calcineurin Inhibitors: A Pediatric Dermatology Perspective

Fiorillo, Loretta; Marcoux, Danielle; Ramien, Michele

doi:10.1177/1203475419857975

Cited by 7 publications

(6 citation statements)

References 58 publications

(133 reference statements)

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“…The largest body of evidence supporting the off-label use of TCIs is in infants age younger than 2 years with atopic dermatitis; this topic is addressed in the accompanying article on the use of TCIs for pediatric atopic dermatitis published in this supplement by Fiorillo et al 14 Other disorders with Level 1 evidence of efficacy are summarized below. i) Vitiligo.…”

Section: Off-label Use Of Tcis That Is Well Supported By the Literaturementioning

confidence: 99%

Off-Label Use of Topical Calcineurin Inhibitors in Dermatologic Disorders

2019

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Off-label prescribing is a common practice in dermatology, particularly when uncommon dermatologic diseases have limited or no approved treatment options. Topical calcineurin inhibitors are approved for the treatment of eczema, and their anti-inflammatory, immunomodulatory, and steroid-sparing effects make them an attractive therapeutic option for a wide variety of other dermatologic diseases. This review summarizes and qualifies the available evidence supporting the clinical effectiveness of tacrolimus ointment and pimecrolimus cream in non-eczema indications. There is high-quality evidence supporting the effectiveness of topical calcineurin inhibitors in multiple dermatological disorders including vitiligo; psoriasis of the face, folds, and genitals; seborrheic dermatitis; chronic hand dermatitis; contact dermatitis; oral lichen planus; lichen sclerosus; morphea; and cutaneous lupus erythematosus. Lower-quality evidence suggests they may be considered as an option in many other cutaneous disorders.

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Section: Off-label Use Of Tcis That Is Well Supported By the Literaturementioning

confidence: 99%

Off-Label Use of Topical Calcineurin Inhibitors in Dermatologic Disorders

2019

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“…8 If topical treatments were to induce systemic immunosuppression and increase the infections rate, detectable blood levels or lowered vaccination responses should be observable. 9,10 In this study, we aimed to compare safety differences between topical TAC (0.03% and 0.1% ointments) and TCS (mild and moderate potency) in a cohort of young children with moderate to severe AD.…”

Section: Introductionmentioning

confidence: 99%

“…However, there have been reports associating severe and uncontrolled AD with increased cutaneous infections and a slightly elevated risk of developing malignancies, especially cutaneous lymphomas 8 . If topical treatments were to induce systemic immunosuppression and increase the infections rate, detectable blood levels or lowered vaccination responses should be observable 9,10 …”

Section: Introductionmentioning

confidence: 99%

Safety of tacrolimus 0.03% and 0.1% ointments in young children with atopic dermatitis: a 36‐month follow‐up study

Salava

Perälä

Pelkonen

et al. 2022

Clin Experimental Derm

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Background. Topical tacrolimus is used off-label in young children, but data are limited on its use in children under 2 years of age and for long-term treatment. Aim. To compare safety differences between topical tacrolimus (0.03% and 0.1% ointments) and topical corticosteroids (mild and moderate potency) in young children with atopic dermatitis (AD). Methods. We conducted a 36-month follow-up study with 152 young children aged 1-3 years with moderate to severe AD. The children were followed up prospectively, and data were collected on infections, disease severity, growth parameters, vaccination responses and other relevant laboratory tests were gathered. Results. There were no significant differences between the treatment groups for skin-related infections (SRIs) (P = 0.20), non-SRIs (P = 0.20), growth parameters height (P = 0.60), body weight (P = 0.81), Eczema Area and Severity Index (EASI) (P = 0.19), vaccination responses (P = 0.62), serum cortisone levels (P = 0.23) or serum levels of interleukin (IL)-4, IL-10, IL-12, IL-31 and interferon-c. EASI decreased significantly in both groups (P < 0.001). In the tacrolimus group, nine patients (11.68%) had detectable tacrolimus blood concentrations at the 1-week visit. There were no malignancies or severe infections during the study, and blood eosinophil counts were similar in both groups. Conclusions. Topical tacrolimus (0.03% and 0.1%) and topical corticosteroids (mild and moderate potency) are safe to use in young children with moderate to severe AD, and have comparable efficacy and safety profiles.

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“…T opical calcineurin inhibitors are a family of drugs that have been touted for having high efficacy without the risks of cutaneous atrophy and systemic absorption seen with topical corticosteroids.1 They may play an important role in the elderly population, where preexisting cutaneous atrophy increases susceptibility to these adverse effects. [1][2][3] Until 2014, the topical calcineurin inhibitors were only available as branded medications; however, in 2014, generic tacrolimus ointment entered the United States' prescription drug market. There is currently little information regarding usage trends in the elderly, and how usage and costs were impacted by generic availability of tacrolimus.…”

Section: Introductionmentioning

confidence: 99%

“…There is currently little information regarding usage trends in the elderly, and how usage and costs were impacted by generic availability of tacrolimus. 2,4 We aim to systematically analyze prescription claims and costs for calcineurin inhibitors in the Medicare population.…”

Section: Introductionmentioning

confidence: 99%