Effect of topical calcineurin inhibitors as monotherapy or combined with phototherapy for vitiligo treatment: a meta-analysis

Abstract

Vitiligo is a common skin disease for which immunomodulating calcineurin inhibitors have been considered reasonable treatment. We searched the MEDLINE, Embase, and Cochrane central register of controlled trials databases for articles published prior to September 2014. Thirteen studies were included in the meta-analysis. After pooling the trials, we concluded that calcineurin inhibitors showed a better therapeutic effect on vitiligo than placebo, according to lesion report (RR = 2.62, 95%CI, 1.39-4.93, p = 0.003) and patient report (RR = 1.42, 95%, 0.87-2.31, p = 0.157). Subgroup analysis was performed to determine whether the combination with phototherapy was a source of heterogeneity. The trial sequence analysis indicated that the results of combined therapy by lesion report were reliable and conclusive. However, in the patient report trials, the frequency of lesions on the hand and foot was higher, and the effect of combined therapy was still not significant. Calcineurin inhibitors showed a better therapeutic effect than placebo in the treatment of vitiligo with phototherapy. However, the typical UV-resistant sites (i.e., hand and foot) were still difficult to cure even with combined therapy. Because of concerns about photocarcinogenesis, the clinical application of combined therapy should be explored with caution.

Effect of narrow band ultraviolet B phototherapy as monotherapy or combination therapy for vitiligo: a meta‐analysis

“…Although there are many therapeutic options such as medicine, phototherapy, and surgical grafts, the treatment of vitiligo is still one of the most difficult dermatological challenges . Resistance and side effects of treatments are major problems that dermatologists need to face .…”

Off-Label Use of Topical Calcineurin Inhibitors in Dermatologic Disorders

“…[15][16][17][18][19][20][21] In addition, maintenance therapy with twice-weekly tacrolimus 0.1% ointment may prevent depigmentation in repigmented lesions. 22 Systematic reviews and meta-analyses support a combination approach consisting of TCIs and phototherapy in the form of narrow-band ultraviolet B radiation 23,24 or 308-nm excimer laser therapy. 25,26 British guidelines suggest TCIs may be considered for adults and children with vitiligo as an alternative to TCS given their better short-term safety profile.…”

<p>Home phototherapy for patients with vitiligo: challenges and solutions</p>

“…Since the pathogenesis of vitiligo is not fully understood, a variety of modalities have been attempted to stabilize progression and stimulate repigmentation 9–13. These include topical therapies9 (eg, topical corticosteroids,9,12,14,15 calcineurin inhibitors,9,16,17 vitamin D analogues9,12,18), systemic therapies19 (eg, corticosteroids,9,12 methotrexate9), surgical therapies20 (eg, melanocyte-keratinocyte transplantation,21–25 hair follicle transplant,26,27 punch, blister, split thickness grafting26–28), complementary and alternative therapies29 (eg, L-phenylalanine, khellin, biloba, folic acid, zinc, copper, vitamins B12, C, D, and E), and a variety of experimental therapies (eg, afamelanotide,19,30 topical prostaglandin E2,19,31 systemic and topical Janus kinase inhibitors,19,32–34 apremilast,19 topical Wnt agonists19).…”