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Comparative Effectiveness of Topical Calcineurin Inhibitors in Adult Patients with Atopic Dermatitis

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Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by extreme pruritis and lichenified papules and plaques that may begin in or persist into adulthood. Topical corticosteroids are firstline prescription therapy for AD; they are efficacious and have a well established safety profile. The topical calcineurin inhibitors tacrolimus and pimecrolimus were approved by the US FDA in 2000 and 2001, respectively, as second-line topical therapy for AD. This review evaluates the available studies on the comparative effectiveness, safety, cost, and impact on quality of life of topical corticosteroids and topical calcineurin inhibitors for the treatment of adult AD.

Tacrolimus was found to be as effective as class III–V topical corticosteroids for AD of the trunk and extremities, and more effective than low-potency class VI or VII corticosteroids for AD of the face or neck. Pimecrolimus was less effective than both tacrolimus and low-potency topical corticosteroids for moderate to severe AD. The short-term safety studies found that, compared with topical corticosteroid-treated adults, patients treated with topical calcineurin inhibitors had an increased frequency of application-site reactions, an equivalent infection risk, and a decreased risk of skin atrophy. The long-term safety of topical calcineurin inhibitors remains under investigation. Currently published studies that evaluated the comparative cost and quality-of-life effects compared tacrolimus with less potent topical corticosteroids despite the availability of equivalent potency corticosteroids. Further cost and quality-of-life studies are needed that compare topical calcineurin inhibitors with stronger classes of topical corticosteroids over longer time periods.

The available clinical trials data do not suggest an efficacy advantage for topical calcineurin inhibitors over topical corticosteroids in adults with AD of the trunk and extremities, and there is not yet adequate evidence to support topical calcineurin inhibitors as first-line therapy for adult AD.

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Acknowledgments

No sources of funding were used to prepare this article. AAQ serves as a consultant to Novartis and the US Center for Disease Control. HCF has no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Dermatology, Aluminae Hall, Brigham and Women’s Hospital and Harvard Medical School, 02115, 75 Francis Street, Boston, MA, USA

    Hillary C. Frankel &  Abrar A. Qureshi

  2. Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Abrar A. Qureshi

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  1. Hillary C. Frankel
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Correspondence to Abrar A. Qureshi.

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Frankel, H.C., Qureshi, A.A. Comparative Effectiveness of Topical Calcineurin Inhibitors in Adult Patients with Atopic Dermatitis. Am J Clin Dermatol 13, 113–123 (2012). https://doi.org/10.2165/11597780-000000000-00000

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