BMJ 2000;320:963-967 ( 8 April )

Papers

Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis

Darren M Ashcroft, research lecturer, ^a Alain Li Wan Po, professor of clinical pharmaceutics, ^a Hywel C Williams, professor of dermatoepidemiology, ^b Christopher E M Griffiths, professor of dermatology. ^c

^a Centre for Evidence-Based Pharmacotherapy, School of Life and Health Sciences, Aston University, Birmingham B4 7ET, ^b Department of Dermatology, Queen's Medical Centre, Nottingham NG7 2UH, ^c Section of Dermatology, University of Manchester, Hope Hospital, Salford M6 8HD

Correspondence to: A Li Wan Po a.liwanpo{at}aston.ac.uk

Objectives: To evaluate the comparative efficacy and tolerability of topical calcipotriol in the treatment of mild to moderate chronic plaque psoriasis.
Design: Quantitative systematic review of randomised controlled trials.
Subjects: 6038 patients with plaque psoriasis reported in 37 trials.
Main outcome measures: Mean difference in percentage change in scores on psoriasis area and severity index, and response rate ratios for both patients' and investigators' overall assessments of marked improvement or better. Adverse effects were estimated with the rate ratio, rate difference, and number needed to treat.
Results: Calcipotriol was at least as effective as potent topical corticosteroids, calcitriol, short contact dithranol, tacalcitol, coal tar, and combined coal tar 5%, allantoin 2%, and hydrocortisone 0.5%. Calcipotriol caused significantly more skin irritation than potent topical corticosteroids (number needed to treat to harm for irritation 10, 95% confidence interval 6 to 34). Calcipotriol monotherapy also caused more irritation than calcipotriol combined with a potent topical corticosteroid (6, 4 to 8). However, the number needed to treat for dithranol to produce lesional or perilesional irritation was 4 (3 to 5). On average, treating 23 patients with short contact dithranol led to one more patient dropping out of treatment owing to adverse effects than if they were treated with calcipotriol.
Conclusions: Calcipotriol is an effective treatment for mild to moderate chronic plaque psoriasis, more so than calcitriol, tacalcitol, coal tar, and short contact dithranol. Only potent topical corticosteroids seem to have comparable efficacy at eight weeks. Although calcipotriol caused more skin irritation than topical corticosteroids this has to be balanced against the potential long term effects of corticosteroids. Skin irritation rarely led to withdrawal of calcipotriol treatment. Longer term comparative trials of calcipotriol versus dithranol and topical corticosteroids are needed to see whether these short term benefits are mirrored by long term outcomes such as duration of remission and improvement in quality of life.

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