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Topical Calcineurin Inhibitors in the Treatment of Atopic Dermatitis

A Meta-Analysis of Current Evidence

  • Original Research Article
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American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Purpose: To summarize success rates of the topical calcineurin inhibitors tacrolimus and pimecrolimus in treating atopic dermatitis.

Methods: Randomized controlled trials (RCTs) comparing either drug to themselves (i.e. dose-ranging studies), each other, the vehicle (or placebo), or corticosteroids were obtained from Medline, EMBASE, and Cochrane databases. Two reviewers identified studies and extracted data, a third reviewer adjudicated disagreements. Outcomes included success, as defined by 90%, 75%, or 50% reductions from baseline in Eczema Area and Severity Index (EASI) scores or equivalent at 1, 3, 6, and 12 months, and also the difference between drug and vehicle (placebo). Rates were combined using a random effects meta-analytic model.

Results: Of 180 articles identified, 165 were rejected (142 not RCTs/inappropriate outcome, 23 inappropriate/unextractable data). We included 15 articles reporting on 16 trials (nine tacrolimus and seven pimecrolimus trials) involving a total of 5301 patients, of whom 2107 received tacrolimus, 1225 received pimecrolimus and 1969 patients were controls. Tacrolimus reduced EASI scores by 65.6% at 1 month and 73.0% at 3 months; pimecrolimus reduced scores by 61.5% at 1 month, 60.3% at 6 months, and 61.9% at 12 months. When the difference in EASI score reductions were compared between active drug and placebo, tacrolimus success was 51.5% above placebo at 1 month and pimecrolimus was 45.9% higher at 1 month, 24.9% at 6 months, and 16.1% at 12 months.

Conclusions: Success rates for tacrolimus and pimecrolimus were statistically similar. However, tacrolimus rates were consistently higher numerically than those for pimecrolimus, and tacrolimus was used in patients with more severe disease. A head-to-head RCT is required to determine if true differences exist between these drugs.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgment

This study was funded by Fujisawa Canada Inc. The authors would Like to acknowledge Linda Barkovsky for her administrative and editorial assistance.

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Authors and Affiliations

  1. PharmIdeas Research & Consulting Inc., 1175 North Service Road West, Suite 211, Oakville, Ontario, L6M 2W1, Canada

    Michael Iskedjian, Charles Piwko &  Thomas R. Einarson

  2. Department of Clinical Pharmacology, Hospital for Sick Children, Toronto, Ontario, Canada

    Charles Piwko &  Thomas R. Einarson

  3. Department of Dermatology, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario, Canada

    Neil H. Shear

  4. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Neil H. Shear &  Thomas R. Einarson

  5. Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada

    Neil H. Shear &  Thomas R. Einarson

  6. Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, Canada

    Richard G.B. Langley

  7. Division of Dermatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

    Richard G.B. Langley

Authors
  1. Michael Iskedjian
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  2. Charles Piwko
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  3. Neil H. Shear
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  4. Richard G.B. Langley
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  5. Thomas R. Einarson
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Correspondence to Thomas R. Einarson.

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Iskedjian, M., Piwko, C., Shear, N.H. et al. Topical Calcineurin Inhibitors in the Treatment of Atopic Dermatitis. Am J Clin Dermatol 5, 267–279 (2004). https://doi.org/10.2165/00128071-200405040-00006

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