Low-Dose Acitretin Is Associated With Fewer Adverse Events Than High-Dose Acitretin in the Treatment of Psoriasis

Optimizing acitretin use in patients with plaque psoriasis

“…Similar results are observed in other studies, that even with comparable efficacy of 25 and 50 mg acitretin, the benefit:risk ratio was in favor of 25 mg, thus, suggested the 25 mg as optimal dose (Dogra et al, 2013;Haushalter et al, 2012;Pearce et al, 2006). Low acitretin doses, namely 10 mg and 25 mg daily, are preferred as starting dosages that could be eventually increased (Berbis et al, 1989;Dogra et al, 2013;Haushalter et al, 2012;Pearce et al, 2006). According to blinded, placebo-controlled trials, we used the 25 mg daily dosage that could be considered therapeutically effective with a reduced risk of side effects.…”

“…In a randomized, double blind, parallel group, dose ranging study, testing 25, 35, and 50 mg/day acitretin dose, PASI 75 (at least 75% improvement of the baseline psoriasis area severity index, PASI score) response rate was higher in the 35 mg group (69% of treated patients), as compared with 25 mg‐ and 50 mg‐treated groups achieving PASI 75 in 47% and 53% of cases, respectively (Berbis et al, ). Similar results are observed in other studies, that even with comparable efficacy of 25 and 50 mg acitretin, the benefit:risk ratio was in favor of 25 mg, thus, suggested the 25 mg as optimal dose (Dogra et al, ; Haushalter et al, ; Pearce et al, ). Low acitretin doses, namely 10 mg and 25 mg daily, are preferred as starting dosages that could be eventually increased (Berbis et al, ; Dogra et al, ; Haushalter et al, ; Pearce et al, ).…”

“…Indeed, a recent head-to-head study published in 2013 on a small cohort of patients, showed a reduced acitretin efficacy vs. methotrexate in treating plaque psoriasis with palmoplantar localization (Janagond, Kanwar, & Handa, 2013 (Berbis et al, 1989). Similar results are observed in other studies, that even with comparable efficacy of 25 and 50 mg acitretin, the benefit:risk ratio was in favor of 25 mg, thus, suggested the 25 mg as optimal dose (Dogra et al, 2013;Haushalter et al, 2012;Pearce et al, 2006). Low acitretin doses, namely 10 mg and 25 mg daily, are preferred as starting dosages that could be eventually increased (Berbis et al, 1989;Dogra et al, 2013;Haushalter et al, 2012;Pearce et al, 2006).…”

Fixed Tapering Dosage of Acitretin in Patients with Psoriasis: A Short-Term Analysis of Clinical Efficacy and its Effects on Biochemical Parameters

“…[1315] In our study the maximum increase was noted in the 1 st and 2 nd week when patients were on 50 mg of acitretin, which steadily decreased with decreasing dosage. Similar findings were noted in a study by Pearce et al [16] Dogra et al noticed an increase in serum cholesterol and triglyceride levels above the upper limit of normal in 7 (11%) and 12 (20%) patients, respectively. [1] Though an increase in triglycerides, cholesterol and LDL was noted above the normal limits in many patients in our study [Figures 2 and 5], more than half returned to normal limits or near baseline levels with the reduction in dosage [Figure 3].…”

Efficacy and safety of acitretin in three fixed doses of 25, 35 and 50 mg in adult patients with severe plaque type psoriasis: a randomized, double blind, parallel group, dose ranging study

“…Common adverse effects observed in our study were mucocutaneous and musculoskeletal. Overall frequency of these adverse effects was dose dependent, which has also been noted in previous studies 23,24 . The mucocutaneous adverse effects resolved in majority of the patients with continued treatment indicating development of tolerance to these side‐effects.…”