Optimizing therapy: tazarotene in combination with phototherapy

Abstract

Phototherapy is often used in combination with other antipsoriatic treatments in an attempt to improve efficacy and reduce patients' cumulative exposure to radiation. Although this aim has been achieved with some combinations, the additional therapies often introduce a potential risk of other tolerability and safety problems. The efficacy of tazarotene reported in clinical trials to date suggest that this drug may help to improve the efficacy of phototherapy, and perhaps reduce the ultraviolet light exposure required without introducing additional, clinically significant problems. Preliminary results from the first 10 patients in a clinical trial investigating such combination therapy are reported here. They demonstrate that the addition of tazarotene to UVB phototherapy increases the percentage of patients achieving treatment success (> or = 50% global improvement in psoriasis) from 60% to 100% at Day 81. The UVB plus tazarotene combination achieved consistently greater reductions in the elevation and scaling of difficult-to-treat psoriatic plaques than UVB phototherapy alone or UVB phototherapy plus vehicle gel. The tazarotene combination therapy also achieved initial treatment success in less than half the time needed with phototherapy alone (median of 32 vs. 67 days). Combining UVB phototherapy with tazarotene treatment appears to offer a valuable therapeutic option that is more efficacious and faster than UVB phototherapy alone.

The efficacy of topical tazarotene monotherapy and combination therapies in psoriasis

“…Although Lowe et al [36,37] and Koo et al [38,39] noted no significant photosensitivity with the use of 0.1% tazarotene gel applied three times weekly, other studies suggest caution. Hecker et al [40] studied 12 healthy volunteers to determine whether the application of topical tazarotene increases the subject's susceptibility to burn when exposed to UV light [40].…”

“…In an investigator-masked study of 54 psoriasis patients, the effect of tazarotene and BB-UVB was studied [36]. Bilateral target plaques were randomised to receive two of the following regimens: 0.1% tazarotene gel, vehicle gel or no treatment.…”

“…Although Hecker et al [40], Lowe et al [36,37] and Koo et al [38,39] pretreated their subjects with similar regimens of 0.1% tazarotene gel for 2 weeks prior to initiating UVB therapy, the different methodologies may explain the different findings with respect to photosensitivity. In the study by Hecker et al [40], tazarotene was applied to the normal non-indurated skin of healthy volunteers, whereas in studies by Lowe et al [36,37] and Koo et al [38,39], tazarotene was applied to psoriatic target plaques hand-picked for their most scaly and indurated morphology.…”

“…In the study by Hecker et al [40], tazarotene was applied to the normal non-indurated skin of healthy volunteers, whereas in studies by Lowe et al [36,37] and Koo et al [38,39], tazarotene was applied to psoriatic target plaques hand-picked for their most scaly and indurated morphology.…”

Aktuelle Aspekte der topischen Psoriasisbehandlung

“…Hautreizungen in Form von Pruritus,Brennen und Erythemen treten bei nicht wenigen der behandelten Patienten auf.Diese Nebenwirkungen lassen sich durch eine Kombination mit mittelstark bis stark wirksamen Kortikosteroiden reduzieren, was auch die Effektivität der Behandlung steigern soll [13].Auch in Kombination mit UVB-Licht kann eine additive antipsoriatische Wirkung erzielt und die kumulative UV-Dosis gesenkt werden [14].…”