Long-Term Proactive Treatment of Plaque Psoriasis with Calcipotriene/Betamethasone Dipropionate Foam Prolongs Remission and Reduces Relapses Irrespective of Patient Baseline Characteristics

Lebwohl, Mark; Papp, Kim; Mørch, Marie Holst; Bernasconi, Marie Y. Jablonski; Warren, Richard B.

doi:10.1007/s13555-021-00585-x

Cited by 4 publications

(6 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Importantly, it is the only treatment that is effective in reducing the neutrophil population in psoriasis skin. Although the 4 week treatment was not long enough to see changes in cell populations such as NK cells or gamma delta T cells and may therefore be a limitation of this study, its clear effectiveness on pathogenic CD8 T cells and neutrophils is likely to explain its long‐term disease control and reduced number of relapses in psoriasis patients 7,38 …”

Section: Discussionmentioning

confidence: 99%

“…Recent studies suggest that topical treatment of Betamethasone dipropionate with vitamin D analogue (Calcipotriol) had better clinical efficacy (improvement in PASI score, Psoriasis Area Severity Index) than Betamethasone or Calcipotriol alone and is associated with few side effects and better long‐term management of the disease 4–6 . When given in aerosol foam, combined treatment increases skin absorption, has a rapid onset of action, reduces number of relapses and improves patients quality of life (QoL) 7–9 …”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] When given in aerosol foam, combined treatment increases skin absorption, has a rapid onset of action, reduces number of relapses and improves patients quality of life (QoL). [7][8][9] The cellular mechanisms involved in the effectiveness of this approach are not fully understood. We know that inflammatory cells, particularly CD8+ T cells, 10,11 natural killer (NK) cells 12 and neutrophils 13 are important contributors to pathophysiology of psoriasis.…”

Section: Introductionmentioning

confidence: 99%

“… 4 , 5 , 6 When given in aerosol foam, combined treatment increases skin absorption, has a rapid onset of action, reduces number of relapses and improves patients quality of life (QoL). 7 , 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of topical emollient, steroids alone or combined with calcipotriol, on the immune infiltrate and clinical outcome in psoriasis

Heim

Irondelle

Cardot‐Leccia

et al. 2022

Experimental Dermatology

View full text Add to dashboard Cite

Psoriasis is a chronic inflammatory disease whereby long‐term disease control remains a challenge for the patients. Latest evidence suggests that combined topical treatment with steroids and vitamin D analogue foam (Calcipotriol/Betamethasone) is efficient in long‐term management of the disease and reducing the number of relapses. Its effects on cellular inflammation and cytokine production remain to be explored. We set out to examine the effect of topical therapies on cellular infiltrate and cytokine profile in the lesional skin of psoriasis patients. This was a monocentric, double‐blind, randomized trial with 30 patients. Patients were treated with the combined Calcipotriol/Betamethasone foam, Betamethasone foam alone, Clobetasol Propionate ointment or placebo. 4 mm skin biopsies from lesional and non‐lesional sites were taken before and 4 weeks after treatment. Cellular infiltrate, IFNγ and IL‐17 were studied by immunofluorescence. Each patient was their own control. Evolution in skin inflammation was studied in parallel with changes in patient's epidermal thickness and their tPASI clinical score. Lesional skin was characterized by increased epidermal thickness, increased number of IL‐17 and IFNγ producing CD8+ T cells, NK cells and neutrophils. All treatment reduced epidermal thickness and improved patients tPASI scores. Only the combined Calcipotriol/Betamethasone foam completely abolished epidermal and dermal influx of CD8+ T cells, reduced number of CD8 + IFNγ+ cells (but not CD8 + IL‐17+ cells) and significantly reduced the number of MPO+ neutrophils which were predominantly IL‐17+. None of the treatments had effect on NK cells. We have shown the combined topical treatment with Calcipotriol/Betamethasone foam to be effective in reducing cellular influx into lesional skin of psoriasis patients and this effect to be superior to emollient or Betamethasone alone. Its previously described efficacy in the clinic may be attributed to its unique and rapid ability to inhibit both adaptive CD8+ T cell and innate immune neutrophilia influx into the skin, which was not observed for the other treatments.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of topical emollient, steroids alone or combined with calcipotriol, on the immune infiltrate and clinical outcome in psoriasis

Heim

Irondelle

Cardot‐Leccia

et al. 2022

Experimental Dermatology

View full text Add to dashboard Cite

show abstract

“…Patients on PAM had longer time to first relapse, more days in remission, and fewer relapses [ 4 ]. In post hoc analyses, these favourable efficacy outcomes were most pertinent in patients with moderate psoriasis [ 21 ]. These data support the use of PAM regimens, which in the broader context of psoriasis treatment, may be beneficial in reducing or delaying the need for systemic treatments.…”

Section: Introductionmentioning

confidence: 99%

Expert Consensus on Real-World Use and Consumption Patterns of a Fixed-Dose Combination Foam for Psoriasis as a Reactive Management (RM) and Proactive Management (PAM) Regimen

et al. 2023

View full text Add to dashboard Cite

Introduction: Plaque psoriasis is a chronic skin disease characterised by periods of remission and relapse and associated with considerable burden to patients and healthcare systems. For most patients, standard-of-care is reactive management (RM) with topical therapies, but, more recently, the benefits of proactive management (PAM) have been recognised. This study aimed to gain consensus on real-world use and consumption in RM versus PAM regimens, based on fixed-dose combination calcipotriol and betamethasone dipropionate (Cal/BD) foam which, following a recent update, is currently the only topical therapy for psoriasis with a long-term maintenance regimen in its label. Methods: The modified-Delphi approach was used to gain insights and consensus on realworld views, use and consumption in RM versus PAM from a panel of dermatologists with experience prescribing Cal/BD foam as PAM.The panel included 16 dermatologists, 4 each from France, Germany, Italy, and Spain, and included two questionnaire rounds and a meeting to obtain final consensus. Results: The panel agreed that topicals are burdensome to apply in clinical practice and that poor patient adherence, particularly longterm, is a barrier to effective psoriasis management. The panel advised that, as they prescribe a similar number of cans for RM and PAM over a given period, consumption is not a key driver influencing future decisions to prescribe PAM, even in instances where prescribing differences could be observed. Instead, the panel agreed that patient-and disease-related factors better determine patient suitability for PAM. Conclusion: This modified-Delphi study confirms that prescription of RM or PAM, with Cal/ BD foam, is largely driven by patient-related factors and patient involvement is key to optimise outcomes. Real-world experiences captured in this study suggest that a PAM regimen does not increase overall consumption, and thus costs per patient for payers and prescribers, in comparison to RM.

show abstract

A systematic review of 454 randomized controlled trials using the Dermatology Life Quality Index: experience in 69 diseases and 43 countries

Vyas

Johns

Ali

et al. 2023

British Journal of Dermatology

View full text Add to dashboard Cite

Background Over 29 years of clinical application, the Dermatology Life Quality Index (DLQI) has remained the most used PRO in dermatology due to its robustness, simplicity and ease of use. Objectives This systematic review aimed to generate further evidence of its utility in randomised controlled trials and is the first to cover all diseases and interventions. Methods The methodology followed PRISMA guidelines and included seven bibliographic databases, searching articles published from January 1 1994 until November 16, 2021. Articles were reviewed independently by two assessors, and an adjudicator resolved any opinion differences. Results Of 3220 screened publications, 457 articles meeting eligibility criteria for inclusion, describing research on 198,587 patients, were analysed. DLQI scores were primary endpoints in 24 (5.3%) of studies. Most studies were of psoriasis (53.2%), although 68 different diseases were studied. Most study drugs were systemic (84.3%), with biologics 55.9% of all pharmacological interventions. Topical treatments comprised 17.1% of total pharmacological interventions. Non-pharmacological interventions were 13.8% of the total interventions, mainly laser therapy and UV treatment. 63.6% of studies were multicentre, with trials conducted in at least 42 different countries, and 41.7% were conducted in multiple countries. Minimal importance difference (MID) was reported in analysis of 15.1% of studies, but only 1.3% considered full score meaning banding of DLQI. 61 (13.4%) of studies investigated statistical correlation of DLQI with clinical severity assessment or other PRO/QoL tools. 62% to 86% of studies had within group scores differences greater than the MID in “active treatment arms”. The JADAD risk of bias scale showed that bias was generally low, as 91.4% of studies had JADAD scores of ≥3; only 0.44% of studies showed high risk from randomisation, 13.8% high risk from blinding and 10.4% high risk from unknown outcome of all participants in the studies. 18.3% of studies declared that they followed an intention-to treat (ITT) protocol, and imputation for missing DLQI data was used in 34.1% of studies. Conclusions This systematic review provides a wealth of evidence for use of the DLQI in clinical trials to inform researchers’ and clinicians’ decision for its further use. Recommendations are also made for improving the reporting of data from future RCT trials using DLQI.

show abstract

Long-Term Proactive Treatment of Plaque Psoriasis with Calcipotriene/Betamethasone Dipropionate Foam Prolongs Remission and Reduces Relapses Irrespective of Patient Baseline Characteristics

Cited by 4 publications

References 8 publications

Impact of topical emollient, steroids alone or combined with calcipotriol, on the immune infiltrate and clinical outcome in psoriasis

Impact of topical emollient, steroids alone or combined with calcipotriol, on the immune infiltrate and clinical outcome in psoriasis

Expert Consensus on Real-World Use and Consumption Patterns of a Fixed-Dose Combination Foam for Psoriasis as a Reactive Management (RM) and Proactive Management (PAM) Regimen

A systematic review of 454 randomized controlled trials using the Dermatology Life Quality Index: experience in 69 diseases and 43 countries

Contact Info

Product

Resources

About