SYSTEMATIC REVIEW OF COMPARATIVE EFFICACY AND TOLERABILITY OF CALCIPOTRIOL

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SYSTEMATIC REVIEW OF COMPARATIVE EFFICACY AND
TOLERABILITY OF CALCIPOTRIOL

• Ashcroft, D. Po, ALW. Williams,
  HC.
• Griffiths,CEM. 2000. British
  Medical Journal
• 320 963-967
• Presented by Wislaine Coby

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PURPOSE

• Testing the new method of treatment which is
  calcipotriol (synthetic vitamin D analogue).
• To see how effective calciptriol is, when
  compared to the other medications in treating
  psoriasis.

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PSORIASIS

• One of the most common skin diseases that affects
  more than 7 million adults and children. Its
  characterized by a build up of rough, dry, dead
  skin cells forming thick scales. The
  inflammation can be uncomfortable and painful.
• The disease may persist for week, months, or
  years with periods of remission and recurrence.
• There are no cures at all but there are
  treatments to reduce the degree and harshness of
  the conditions.

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TYPES OF PSORIASIS

• Erythrodermic less common, characterized by red
  scales on the entire skin. This type makes
  temperature and fluid control difficult, placing
  a strain on internal organs.
• Plaque most common, characterized by raised,
  inflamed lesions covered with silver-white
  scales. Researchers will be focusing on this
  particular type.

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CAUSE

• The cause of psoriasis is unknown, although
  researchers believe that some type of stimulus
  triggers the abnormal cell growth in the
  epidermis.
• Example You cut yourself, the skin heals by
  regenerating the top layers. When the wound is
  healed, the process of regeneration stops. But
  with psoriasis skin cells continue to
  proliferate.

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Factors that may trigger the wound healing process

• Stress
• Alcohol
• Environmental factors such as
• exposure to chemicals
• Injury to your skin
• Immune system response to disease

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May be inherited, researchers are still
conducting studies on how the gene is
responsible for the disease It is not
contagious.
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SIGNS AND SYMPTOMS

• Swollen and stiff joints
• Dry, red patches covered with silvery scales
• Small scaling dots
• Lesions
• First you will notice red dotty spots that can be
  very small then slowly get larger, producing a
  silvery white surface scale that can easily shed.
  Patches spread over wide expanses of skin can
  lead to dry or cracking skin, swelling, intense
  itching and pain.

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• Psoriasis can occur anywhere on the body such as
  the knees, scalp, hands, and back.
• Adults and children can develop the disease.
  Caucasians have the highest percentage at
  developing psoriasis and African American have a
  low incidence of the disease.

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METHODS AND MATERIALS

• 6038 patients with psoriasis were randomly
  selected for 37 trials.
• Mean difference was used to determine the percent
  change in the severeness of the disease.
• Rate ratio was used to determine the overall
  improvement of the medication.
• Record adverse effects such as lesions, skin
  irritation and number of people who withdrew from
  the medications due to the adverse effects.

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TREATMENTS USED IN RESEARCH

• Calcipotriol synthetic vitamin D analogue,
  induces terminal epidermal differentiation and
  inhibits epidermal proliferation without having
  any toxic effects. Most commonly used.
• Placebo non-medicated substance, helps to
  relieve symptoms.
• Topical corticosteroids has anti-inflammatory
  and anti-proliferative actions. Used to decrease
  inflammation and flatten plaques.

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• Calcitriol active vitamin D3 metabolite, an
  anti-proliferation
• Coal tar a toxic substance, reduce the size and
  redness of itchy patches
• Short contact dithranol a hydroxyanthrone which
  inhibits a variety of enzymes crucial to reducing
  epidermal proliferation. Also reduces the
  binding of the growth factors.
• Tacalcitol vitamin D3 analogue
• Ultraviolet B very therapeutic, an
  anti-proliferation

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RESULTS

• Out of 37, 25 trials were not used
• because of duplication of reports,
• failure to meet criteria, and patient
• data could not be obtained.

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TREATMENT Withdrawal

• Many patients withdrew from medication
• (33 of 48) because the disease was
• Resolved, meaning that treatment was
• found
• Withdrew from treatment with high potent
• Corticosteroids.

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ADVERSE EFFECTS

• Patients developed lesions and skin irritation.
• Using ditranol caused more lesions

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Figure 1                                        
                                                  
                                                  
                                              
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RATIONALE

• Treatment was more effective with the 8 week
  period than the 6 week period because treatment
  seemed to make adverse effects show less.
• Research shows calcipotriol was favored more in
  treating psoriasis.

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Sensitivity analysis (95 confidence intervals)
of type of patients treated in placebo controlled
trials at eight weeks
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CONCLUSION

• Calcipotriol is indeed an effective drug to
  treat
• mild to moderate psoriasis. Although it may
• cause skin irritation, this drug can still be
  used.
• It is more effective than the other medications.
• Calcipotriol works even better with
• corticosteroid, causing less skin irration.

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REFERENCES

• Fredriksson, t. Petterson, U. 1978. Severe
  psoriasisoral therapy with a new retinoid.
  Dermatoligica 157238-244
• Guttman, C. 2000. Emollient base delivers
  topical corticosteriods with better efficacy.
  Dermatology Time 21 33
• Martin, D. 1998. Journal of Dermatological
  Treatment 9 1-6
• Bark, J. 1995. Psoriasis. Your Skin An
  Owners Guide 157-169