title: Systematic review on the efficacy, safety, and cost-effectiveness of topical calcineurin inhibitors in atopic dermatitis.
abstract: BACKGROUND
  Topical calcineurin inhibitors (TCIs) are widely used as an alternative to topical corticosteroids (TCSs) in treating of atopic dermatitis, but their risk versus benefit compared with TCSs remains unclear.
  
  
  OBJECTIVE
  We performed a systematic review of the efficacy, safety, and cost-effectiveness of TCI compared with TCS and emollients.
  
  
  METHODS
  Published meta-analysis, systematic reviews, and individual studies from January 2005 to January 2015 on the comparative efficacy, safety, and cost-effectiveness of TCI against emollients and TCS were included.
  
  
  RESULTS
  Tacrolimus is comparable to TCS in efficacy, safety profile, and cost-effectiveness. Pimecrolimus has a similar safety profile compared with TCS, emollients, and tacrolimus. It is superior to emollients but inferior to TCS and tacrolimus in efficacy and cost-effectiveness. The association of tacrolimus with malignancy remains uncertain.
  
  
  CONCLUSIONS
  Tacrolimus is an efficacious and cost-effective alternative to TCS, but its benefits need to be weighed against its still uncertain risk for malignancy. Pimecrolimus is appropriate for mild atopic dermatitis when TCS or tacrolimus is unsuitable.
authors.affiliation: From the National Skin Centre, Singapore.
authors.forename: Brian Keng Yong
authors.initials: BK
authors.lastname: Chia
authors.forename: Hong Liang
authors.initials: HL
authors.lastname: Tey
mesh_terms: D000279:Administration, Cutaneous; D065095:Calcineurin Inhibitors / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D006801:Humans; D016559:Tacrolimus / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; C117268:pimecrolimus; D016559:Tacrolimus