Topical Calcipotriol Combined with Phototherapy for Psoriasis

Abstract

Background: Calcipotrial has a well-documented effect in the treatment of psoriasis. Objective: To confirm the beneficial effect of the combination of calcipotriol and UVB and to demonstrate that the combination is safe and well tolerated. Methods: Data from two randomized right/left studies were analysed. Patients included in the studies had chronic stable plaque-type psoriasis with symmetrical lesions on the arms, the legs and/or the trunk. In one study, 101 patients were treated with calcipotriol on one side and calcipotriol + UVB on the other side of the body (open study). In the other study, 77 patients were treated with calcipotriol + UVB on one side and vehicle + UVB on the other side of the body (double-blind study). Calcipotriol ointment, 50 μg/g, was applied twice daily and UVB 3 times weekly for 8 weeks. UVB was increased from 0.7 MED before treatment in rapid steps up to the erythema threshold. Result: In both treatment series the therapeutic effect of the combination of calcipotriol and UVB was enhanced as compared to calcipotriol alone and UVB alone. In the first series there was a significant reduction of the psoriasis area and severity index (PASI) with the combination after 2 weeks as compared to calcipotriol alone. At the end of treatment significantly more sides were cleared after calcipotriol + UVB than after calcipotriol alone. In the other series there was a significantly faster onset of improvement on the sides treated with calcipotriol + UVB than on those treated with vehicle + UVB. After 2 weeks there was a significant difference in PASI in favour of calcipotriol + UVB. At the end of treatment, however, there was no difference between the treatments. There was a similar adverse event profile with either treatment. The addition of UVB to calcipotriol did not alter the tolerability or safety of topically applied calcipotriol. Conclusions: The result indicates a beneficial effect of combining calcipotriol and phototherapy. The findings are compared to other published studies.

Calcipotriol Cream Combined with Twice Weekly Broad-Band UVB Phototherapy: A Safe, Effective and UVB-Sparing Antipsoriatric Combination Treatment

“…The results have shown the combination therapy to be only slightly superior [21, 22]or equal [23]to UVB therapy given either alone or with placebo. The present study was planned to determine whether fewer treatments and a lower total amount of broad-band UVB when used with calcipotriol cream would be as efficacious as a standard form of broad-band UVB therapy used with placebo cream.…”

“…Additionally, calcipotriol ointment has also been used in combination with PUVA [14], cyclosporin [15], acitretin [16], various topical corticosteroids [17]and UVB radiation [18, 19, 20, 21, 22, 23]for treatment of psoriasis.…”

“…In these studies, this combination treatment has been shown to be only slightly superior [21, 22]or equal [23]to a standard UVB phototherapy treatment regime. We hypothesised that if UVB phototherapy is administered in the standard manner, the additive effect of calcipotriol cream may be masked by the effective UVB treatment.…”

Pharmacoeconomic Evaluation of Calcipotriol (Daivonex^®/Dovonex^®) and UVB Phototherapy in the Treatment of Psoriasis: A Markov Model for The Netherlands

“…A number of clinical trials have shown that adding topical calcipotriol cream to the treatment of psoriatic patients receiving such radiation reduces the number of UVB exposures required to achieve treatment success [2, 3]. Fewer UVB treatments may lead to cost savings through decreased direct medical costs, but, for patients, it also results in lower travel costs and less absenteeism from work.…”

Topical Calcipotriol plus Oral Fumaric Acid Is More Effective and Faster Acting than Oral Fumaric Acid Monotherapy in the Treatment of Severe Chronic Plaque Psoriasis vulgaris

“…Calcipotriol has been demonstrated to be equivalent to or more effective than dithranol [8], coal tar [9]and at least as effective as steroids [10, 11]. It is effective in the long term [12]and has been successfully used in combination with systemic treatments [13, 14]and, as well as other vitamin D 3 derivatives, with phototherapy [15, 16, 17]. Calcipotriol is well tolerated, even in children [18], with no effect on hepatic or renal function or calcium haemostasis [19].…”