title: Topical calcipotriol plus oral fumaric acid is more effective and faster acting than oral fumaric acid monotherapy in the treatment of severe chronic plaque psoriasis vulgaris.
abstract: BACKGROUND
  Calcipotriol is an established topical therapy for psoriasis vulgaris.
  
  
  OBJECTIVE
  This study aimed to investigate whether the addition of calcipotriol to fumaric acid ester (FAE) monotherapy had an additive efficacy and an FAE-sparing effect in patients with severe plaque psoriasis.
  
  
  METHODS
  This multicentre, randomised, double-blind, vehicle-controlled study included 143 patients for up to 13 weeks treatment. Group A received FAE tablets (Fumaderm) with an increasing daily dosage from 105 to 1,075 mg + ointment vehicle. Group B received FAE tablets + calcipotriol ointment (50 microg/g). Ointments were applied twice daily. Clinical response was assessed using percentage changes in the Psoriasis Area and Severity Index (PASI), from baseline to treatment end.
  
  
  RESULTS
  The mean percentage change in the PASI was -76.1% in group B and -51.9% in group A, the difference between treatments was -24.2% (95% CI from -34.2 to -14.2%; p < 0.001). Group B responded more rapidly to treatment. Investigators' and patients' overall efficacy assessments were significantly more favourable for group B (p < or = 0.001). Group B was prescribed less FAE than group A. This difference was greatest at the last visit (mean daily dose 529 and 685 mg, respectively; p = 0.006). Overall adverse events in the two groups were similar.
  
  
  CONCLUSIONS
  This study shows that the combination of calcipotriol and FAEs is significantly more effective and faster acting than FAE monotherapy in the treatment of severe plaque psoriasis. The combination has a slight FEA-sparing effect and therefore a superior benefit/risk ratio.
authors.affiliation: Department of Dermatology and Venereology, Otto von Guericke University, Magdeburg, Germany. harald.gollnick@medizin.uni-magdeburg.de
authors.forename: H
authors.initials: H
authors.lastname: Gollnick
authors.forename: P
authors.initials: P
authors.lastname: Altmeyer
authors.forename: R
authors.initials: R
authors.lastname: Kaufmann
authors.forename: J
authors.initials: J
authors.lastname: Ring
authors.forename: E
authors.initials: E
authors.lastname: Christophers
authors.forename: S
authors.initials: S
authors.lastname: Pavel
authors.forename: J
authors.initials: J
authors.lastname: Ziegler
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D002117:Calcitriol / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*; D002908:Chronic Disease; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000069462:Dimethyl Fumarate; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005650:Fumarates / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology
chemical_list: D003879:Dermatologic Agents; D005650:Fumarates; C055085:calcipotriene; D000069462:Dimethyl Fumarate; D002117:Calcitriol