Abstract
Objectives
To build a critical appraisal of the available literature to evaluate the effectiveness
of topical calcineurin inhibitors in treatment of atopic dermatitis (AD), in comparison
to topical corticosteroids (TCs) and/or placebo.
Review methods
Design: systematic review and meta-analysis. Data sources: electronic search of MEDLINE Pubmed along the last 10 years (1997–2006). Study selection: randomized control trials of TCIs reporting efficacy outcomes, in comparison to
TCs or vehicle (placebo) or both. Data synthesis: of 210 articles, 19 studies were included, 10 for tacrolimus and 9 for pimecrolimus, involving
7378 patients of whom 2771 applied tacrolimus, 1783 applied pimecrolimus, and 2824 were controls. Both drugs were significantly more effective than a vehicle. However,
two long-term trials comparing demonstrated the value of pimecrolimus in reduction
of flares and steroid-sparing effect after 6 months. Compared to TCs, both 0.1% and
0.03% tacrolimus ointments were as effective as moderate potency TCs, and more effective
than a combined steroid regimen. Tacrolimus was more effective than mild TCs.
Conclusions
TCIs in AD are more effective than placebo. Although less effective than TCs, pimecrolimus
has its value in long-term maintenance and as a steroid-sparing agent in AD, whenever
used early enough, at first appearance of erythema and/or itching. In treatment of
moderate to severe AD, topical tacrolimus is as effective as moderately potent TCs,
and more effective than mild preparations. Chronic AD lesions of the face and flexures
are the most justified indication for topical calcineurin inhibitors.
Keywords
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Article info
Publication history
Published online: July 12, 2010
Accepted:
February 5,
2009
Received in revised form:
January 28,
2009
Received:
April 22,
2008
Identification
Copyright
© 2009 Japanese Society for Investigative Dermatology. Published by Elsevier Inc. All rights reserved.
