| Topical treatments for chronic plaque psoriasis. | |
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MedLine Citation:
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PMID: 19370616 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Chronic plaque psoriasis is the most common type of psoriasis and is characterised by redness, thickness and scaling. First line management of chronic plaque psoriasis is with topical treatments, including vitamin D analogues, topical corticosteroids, tar-based preparations, dithranol, salicylic acid and topical retinoids. OBJECTIVES: To compare the effectiveness, tolerability and safety of topical treatments for chronic plaque psoriasis with placebo; to compare vitamin D analogues with other topical treatments. SEARCH STRATEGY: The Cochrane Skin Group's Trials Register was searched (2004/12). To update an unpublished 2002 review we also searched CENTRAL in The Cochrane Library (Issue 1,2005); MEDLINE (to 2005/02); EMBASE (to 2005/08); Science Citation Index (to 2005); Biosis (to 2005); Dissertation Abstracts (all publication years); Inside Conferences (all publication years); SIGLE (to 2005); National Research Register (all projects with a start date of 2001 to 2005); metaRegister of Current Controlled Trials. SELECTION CRITERIA: Randomised trials comparing treatments against placebo or against vitamin D analogues in people with chronic plaque psoriasis. DATA COLLECTION AND ANALYSIS: One author extracted study data and assessed study quality. A second author checked these data. We routinely contacted triallists and companies for missing data. We extracted data on withdrawals and adverse events. MAIN RESULTS: The review included 131 RCTs with 21,448 participants. Vitamin D was significantly more effective than placebo, although there was a wide variation in effect size with the standardised mean difference (SMD) ranging from -0.82 (95% CI -1.34 to -0.29) to -1.90 (95% CI -2.09 to -1.71). With one exception, all corticosteroids performed better than placebo, with potent corticosteroids (SMD: -0.95 (95% CI: -1.11 to -0.80; I(2): 61.1%; 17 studies; 2386 participants)) having smaller benefits than very potent corticosteroids (SMD: -1.29 (95% CI: -1.45 to -1.13; I(2): 53.2%; 11 studies; 1571 participants)). Dithranol and tazarotene performed better than placebo. Head-to-head comparisons of vitamin D against potent or very potent corticosteroids found no significant differences. However, combined treatment with vitamin D /corticosteroid performed significantly better than either vitamin D alone or corticosteroid alone. Vitamin D performed better than coal tar, but findings relative to dithranol were mixed. Potent corticosteroids were less likely than vitamin D to cause local adverse events. No comparison of topical agents found a significant difference in systemic adverse effects. AUTHORS' CONCLUSIONS: Corticosteroids perform as well as vitamin D analogues and are associated with a lower incidence of local adverse events. Further research is required to inform long-term maintenance treatment. |
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Authors:
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Anne R Mason; James Mason; Michael Cork; Gordon Dooley; Gladys Edwards |
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Publication Detail:
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Type: Journal Article; Meta-Analysis; Review Date: 2009-04-15 |
Journal Detail:
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Title: Cochrane database of systematic reviews (Online) Volume: - ISSN: 1469-493X ISO Abbreviation: Cochrane Database Syst Rev Publication Date: 2009 |
Date Detail:
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Created Date: 2009-04-16 Completed Date: 2009-06-23 Revised Date: 2013-04-10 |
Medline Journal Info:
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Nlm Unique ID: 100909747 Medline TA: Cochrane Database Syst Rev Country: England |
Other Details:
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Languages: eng Pagination: CD005028 Citation Subset: IM |
Affiliation:
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Centre for Health Economics, University of York, Alcuin A Block, Heslington, York, UK, YO10 5DD. arm10@york.ac.uk |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Topical Adrenal Cortex Hormones / adverse effects, therapeutic use* Bone Density Conservation Agents / adverse effects, therapeutic use* Chronic Disease Humans Psoriasis / drug therapy* Randomized Controlled Trials as Topic Vitamin D / adverse effects, analogs & derivatives*, therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Adrenal Cortex Hormones; 0/Bone Density Conservation Agents; 1406-16-2/Vitamin D |
| Comments/Corrections | |
Comment In:
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Clin Exp Dermatol. 2011 Dec;36(8):929-30
[PMID:
22074375
]
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Update In:
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Cochrane Database Syst Rev. 2013;3:CD005028
[PMID:
23543539
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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