COMPARATIVE LONG-TERM SAFETY AND TOLERABILITY OF COMBINATION CALCIPOTRIOL/BETAMETHASONE DIPROPIONATE THERAPY IN SCALP PSORIASIS
DOI:
https://doi.org/10.48047/hfxw6943Keywords:
Scalp psoriasis, Calcipotriol, Betamethasone dipropionate, Long-term safetyAbstract
Psoriasis of the scalp is widespread, hard to treat, and commonly has poor adherence due to difficulty with topical application and impact of cosmetic acceptability on continued usage. A two-compound scalp formulation containing calcipotriol and betamethasone dipropionate was also designed at a fixed dose to enhance the convenience and tolerability in addition to long-term safety. Methods: This was a long-term randomized comparative safety study, in which 900 adults with a minimum scalp psoriasis of moderate level were randomly assigned to two scalp formulation groups consisting of two compounds and calcipotriol monotherapy (nor 450). Routine clinical practice was followed with regard to the use of treatments once per day, as necessary, and with a 12-month follow-up. The variables of safety were withdrawals, adverse events, adverse drug reactions (ADRs) and events that were potentially linked to long-term exposure to corticosteroids on the scalp. Findings Baseline characteristics did not differ between groups. The percentage of patients who withdrew was less with the two compound formulation compared to calcipotriol (21.3% vs 39.8%) and less patients would have not been withdrawn because of the unacceptable adverse events and inadequate efficacy. The incidence of ADRs in both the two-compound formulation and calcipotriol were lower (17.1% vs 29.6%), as well as pruritus and skin irritation. Such a positive tolerability profile was sustained in exposure (0 to 6 months and 0 to 12 months) in patients who had prolonged exposure to treatment. Judged events which could have been associated with long-term corticosteroid use were rare and had a similar frequency in the groups. Conclusion: Long-term as-needed and once-daily use of the two-compound calcipotriol/betamethasone scalp formulation had a good safety and tolerability profile, decreased withdrawal rates and reduced ADRs than calcipotriol monotherapy without any observed increment in corticosteroid-associated scalp adverse events.
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References
Farber EM, Nall L. Natural history and treatment of scalp psoriasis. Cutis. 1992;49:396–400.
Van de Kerkhof PC, Franssen ME. Psoriasis of the scalp. Diagnosis and management. Am J Clin Dermatol. 2001;2:159–165.
Van de Kerkhof PC, de Hoop D, de Korte J, Kuipers MV. Scalp psoriasis, clinical presentations and therapeutic management. Dermatology. 1998;197:326–334.
Van de Kerkhof PC, de Hoop D, de Korte J, Cobelens SA, Kuipers MV. Patient compliance and disease management in the treatment of psoriasis in the Netherlands. Dermatology. 2000;200:292–298.
Feldman SR, Housman TS. Patients' vehicle preference for corticosteroid treatments of scalp psoriasis. Am J Clin Dermatol. 2003;4:221–224.
Lebwohl M, Ting PT, Koo JY. Psoriasis treatment: traditional therapy. Ann Rheum Dis. 2005;64:ii83–ii86.
Kragballe K, Wildfang IL. Calcipotriol (MC 903), a novel vitamin D3 analogue stimulates terminal differentiation and inhibits proliferation of cultured human keratinocytes. Arch Dermatol Res. 1990;282:164–167.
Barnes L, Altmeyer P, Forstrom L, Stenstrom MH. Long-term treatment of psoriasis with calcipotriol scalp solution and cream. Eur J Dermatol. 2000;10:199–204.
Klaber MR, McKinnon C. Calcipotriol (Dovonex) scalp solution in the treatment of scalp psoriasis: comparative efficacy with 1% coal tar/1% coconut oil/0.5% salicylic acid (Capasal) shampoo and long term experience. J Dermatol Treat. 2000;11:21–28.
Charakida A, Dadzie O, Teixeira F, Charakida M, Evangelou G, Chu AC. Calcipotriol/betamethasone dipropionate for the treatment of psoriasis. Expert Opin Pharmacother. 2006;7:597–606.
Zaghloul SS, Goodfield MJ. Objective assessment of compliance with psoriasis treatment. Arch Dermatol. 2004;140:408–414.
Kragballe K, van de Kerkhof PC. Consistency of data in six phase III clinical studies of a two-compound product containing calcipotriol and betamethasone dipropionate ointment for the treatment of psoriasis. J Eur Acad Dermatol Venereol. 2006;20:39–44.
Buckley C, Hoffmann V, Shapiro J, Saari S, Cambazard F, Milsgaard M. Calcipotriol plus betamethasone dipropionate scalp formulation is effective and well tolerated in the treatment of scalp psoriasis: a phase II study. Dermatology. 2008;217:107–113.
Jemec GBE, Ganslandt C, Ortonne JP, Poulin Y, Burden AD, de Unamuno P, Berne B, Figueiredo A, Austad J. A new scalp formulation of calcipotriene plus betamethasone compared with its active ingredients and the vehicle in the treatment of scalp psoriasis: a randomized double-blind, controlled trial. J Am Acad Dermatol. 2008;59:455–463.
Van de Kerkhof PCM, Hoffmann V, Anstey A, Barnes L, Bolduc C, Reich K, Saari S, Segaert S, Vaillant L. A new scalp formulation of calcipotriol plus betamethasone dipropionate compared with each of its active ingredients in the same vehicle for the treatment of scalp psoriasis: a randomized, double-blind controlled trial. Br J Dermatol, in press.
International Conference on Harmonisation (ICH) of Technical Requirements for Registration of Pharmaceutical Use: Guideline for Industry, E1A: the Extent of Population Exposure Required to Assess Clinical Safety for Drugs Intended for Long-Term Treatment of Non-Life-Threatening Conditions. Geneva, ICH, 1994, pp 1–4.
Kragballe K, Austad J, Barnes L, Bibby A, de la Brassinne M, Cambazard F, Fleming C, Heikkila H, Jolliffe D, Peyri J, Svensson A, Toole J, Wozel G. A 52-week randomized safety study of a calcipotriol/betamethasone dipropionate two-compound product (Dovobet®/Daivobet®/Taclonex®) in the treatment of psoriasis vulgaris. Br J Dermatol. 2006;154:1155–1160.
Berth-Jones J, Damstra RJ, Golsch S, Livden JK, Van Hooteghem O, Allegra F, Parker CA, Multinational Group. Twice weekly fluticasone propionate added to emollient maintenance treatment to reduce risk of relapse in atopic dermatitis: randomised, double blind, parallel group study. BMJ. 2003;326:1367.
Andreassi L, Giannetti A, Milani M. Efficacy of betamethasone valerate mousse in comparison with standard therapies on scalp psoriasis: an open, multicentre, randomized, controlled, cross-over study on 241 patients. Br J Dermatol. 2003;148:134–138.
Mazzotta A, Esposito M, Carboni I, Schipani C, Chimenti S. Clobetasol propionate foam 0.05% as a novel topical formulation for plaque-type and scalp psoriasis. J Dermatolog Treat. 2007;18:84–87.
Griffiths CE, Finlay AY, Fleming CJ, Barker JN, Mizzi F, Arsonnaud S. A randomized, investigator-masked clinical evaluation of the efficacy and safety of clobetasol propionate 0.05% shampoo and tar blend 1% shampoo in the treatment of moderate to severe scalp psoriasis. J Dermatolog Treat. 2006;17:90–95.
Kragballe K, Barnes L, Hamberg KJ, Hutchinson P, Murphy F, Moller S, Ruzicka T, Van de Kerkhof PC. Calcipotriol cream with or without concurrent topical corticosteroid in psoriasis: tolerability and efficacy. Br J Dermatol. 1998;139:649–654.
Kristensen JK, Wadskov S, Henriksen O. Dose-dependent effect of topical corticosteroids on blood flow in human cutaneous tissue. Acta Derm Venereol. 1978;58:145–148.
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