Topical calcineurin inhibitors in atopic dermatitis: a systematic review and meta-analysis.
OBJECTIVE
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.


METHODS



METHODS
systematic review and meta-analysis.


METHODS
electronic search of MEDLINE Pubmed along the last 10 years (1997-2006).


METHODS
randomized control trials of TCIs reporting efficacy outcomes, in comparison to TCs or vehicle (placebo) or both.


RESULTS
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.
El-Batawy
Mohammad Maged Y
MM
Department of Dermatology, Faculty of Medicine, Cairo University, Egypt.
Bosseila
Manal A-W
MA
Mashaly
Heba M
HM
Hafez
Vanessa Suzan G A
VS
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000276:immunology; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016559:Tacrolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D000305:Adrenal Cortex Hormones; D065095:Calcineurin Inhibitors; D004791:Enzyme Inhibitors; D007166:Immunosuppressive Agents; C117268:pimecrolimus; D016559:Tacrolimus