Topical long‐term therapy of psoriasis with vitamin D₃ analogues, corticosteroids and their two compound formulations: position paper on evidence and use in daily practice

Abstract

SummaryBackground: Current data from daily practice show that vitamin D 3 analogues, corticosteroids and their fixed combination products are used heterogeneously for topical long-term treatment of psoriasis.Aim: To evaluate scientific evidence about topical long-term therapy with vitamin D 3 analogues, corticosteroids and their two-compound-products in psoriasis vulgaris and scalp psoriasis and to develop daily practice recommendations. Methods: Systematic literature review via PubMed® and Embase® and informal expert consensus.Results: The search strategy identified 21 relevant clinical trials. Best evidence regarding topical long term treatment was available for the two-compound-formulation containing calcipotriene and betamethasone. In a comparative trial in psoriasis vulgaris the two-compound-formulation showed superior tolerability and cost effectiveness compared to monotherapy. In scalp psoriasis the two-compound-gel was superior compared to calcipotriene monotherapy. Standardized and simplified treatment application modes resulted in a better clinical outcome comparing to on-demand therapies.Daily practice recommendations: Patients should be proactively involved in the choice of treatment, formulation and mode of application. Besides long-term treatment with the two-compound-formulation other treatment regimens including calcipotriene monotherapy can also be considered. Due to a favorable risk-benefit ratio in maintenance trials and due to better cost-effectiveness the application of two-compound-products once or twice a week after initial therapy is recommended.

Optimal maintenance treatment with calcipotriol/betamethasone dipropionate gel in Korean patients with psoriasis vulgaris: a multicentre randomized, controlled clinical trial

“…In view of the chronic nature of psoriasis, long‐term treatment of the disorder is often necessary. Long‐term treatment using a two‐compound formulation once or twice weekly is recommended by some experts . However, the optimal dosing regimen for long‐term maintenance therapy is not clear.…”

Immunopathology alters Th17 cell glucocorticoid sensitivity

“…Topical glucocorticoids are the most frequently prescribed medication for controlling outbreaks of psoriasis . Glucocorticoids, independently or together with vitamin D3, through their anti‐inflammatory actions reduce plaques and relieve associated symptoms . Recent clinical trials targeting Th17 pathways have been remarkably successful.…”

Prospective, Observational, Non-Interventional, Multicentre Study on the Efficacy and Tolerability of a New Calcipotriol/Betamethasone Aerosol Foam (Enstilar®) in Patients with Plaque Psoriasis under Daily Practice Conditions

“…Several prospective studies and a meta-analysis of the Cochrane Database showed that the fixed-dose combination of vitamin D 3 and corticosteroids is superior compared to the administration of either substance on its own [7, 8]. …”