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Improvements similar for atopic dermatitis patients taking calcineurin inhibitors, corticosteroids

Patients taking calcineurin inhibitors or corticosteroids for treatment of atopic dermatitis showed similar improvements, but costs and rates of skin burning and pruritis were greater among those assigned calcineurin inhibitors, according to recent analysis results.

Joris A. Broeders, MD, PhD, from the department of dermatology at Royal North Shore Hospital in Sydney, Australia, and colleagues performed a systematic review of studies comparing topical calcineurin inhibitors and corticosteroids in both children and adults. The researchers identified 12 independent randomized clinical trials that included patients taking calcineurin inhibitors (n = 3,492) or corticosteroids (n = 3,462).

They found similar improvement in both groups: 81% improvement in the calcineurin inhibitors group and 71% in the corticosteroids group (RR = 1.18; 95% CI, 1.04-1.34). Treatment success also was comparable, with 72% in the calcineurin inhibitors group vs. 68% in the corticosteroids group (RR = 1.15; 95% CI, 1-1.31), the researchers wrote.

Patients assigned calcineurin inhibitors experienced higher costs and more adverse events (74%) than those taking corticosteroids (64%; RR = 1.28; 95% CI, 1.05-1.58). These adverse events included a higher risk for skin burning (30% vs 9%; RR = 3.27; 95% CI, 2.48-4.31) and pruritis (12% vs 8%; RR = 1.49; 95% CI, 1.24-1.79). The investigators, however, reported no significant differences among rates of skin infections, atrophy or other adverse events that prompted discontinuation of therapy.

Study limitations noted by the researchers were the small number of trials that reported costs (n = 2) and that the results were obtained from studies with strict protocols and follow-ups of randomized control trials.

“The current review pools studies that treated atopic dermatitis of the entire body; it would be valuable to perform an RCT with focus on application of calcineurin inhibitors and corticosteroids to the face only, with specific outcomes such as glaucoma and cataracts,” Broeders and colleagues wrote. “These results provide level-1a support for the continued use of corticosteroids as the therapy of choice for atopic dermatitis.” – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.