Topical calcipotriol combined with phototherapy for psoriasis. The results of two randomized trials and a review of the literature. Calcipotriol-UVB Study Group.
BACKGROUND
Calcipotrial has a well-documented effect in the treatment of psoriasis.


OBJECTIVE
To confirm the beneficial effect of the combination of calcipotriol and UVB and to demonstrate that the combination is safe and well tolerated.


METHODS
Data from two randomized right/left studies were analysed. Patients included in the studies had chronic stable plaque-type psoriasis with symmetrical lesions on the arms, the legs and/or the trunk. In one study, 101 patients were treated with calcipotriol on one side and calcipotriol + UVB on the other side of the body (open study). In the other study, 77 patients were treated with calcipotriol + UVB on one side and vehicle + UVB on the other side of the body (double-blind study). Calcipotriol ointment, 50 microg/g, was applied twice daily and UVB 3 times weekly for 8 weeks. UVB was increased from 0.7 MED before treatment in rapid steps up to the erythema threshold.


RESULTS
In both treatment series the therapeutic effect of the combination of calcipotriol and UVB was enhanced as compared to calcipotriol alone and UVB alone. In the first series there was a significant reduction of the psoriasis area and severity index (PASI) with the combination after 2 weeks as compared to calcipotriol alone. At the end of treatment significantly more sides were cleared after calcipotriol + UVB than after calcipotriol alone. In the other series there was a significantly faster onset of improvement on the sides treated with calcipotriol + UVB than on those treated with vehicle + UVB. After 2 weeks there was a significant difference in PASI in favour of calcipotriol + UVB. At the end of treatment, however, there was no difference between the treatments. There was a similar adverse event profile with either treatment. The addition of UVB to calcipotriol did not alter the tolerability or safety of topically applied calcipotriol.


CONCLUSIONS
The result indicates a beneficial effect of combining calcipotriol and phototherapy. The findings are compared to other published studies.
Molin
L
L
Department of Dermatology, Orebro Medical Center Hospital, Sweden. lars.molin@orebroll.se
D000279:Administration, Cutaneous; D002117:Calcitriol / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005499:Folliculitis / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010789:Phototherapy / Q000009:adverse effects; D011565:Psoriasis / Q000473:pathology / Q000628:therapy*; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects; D013471:Sunburn / Q000209:etiology; D016896:Treatment Outcome; D014466:Ultraviolet Rays
D003879:Dermatologic Agents; C055085:calcipotriene; D002117:Calcitriol