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Efficacy and tolerability of proactive treatment with topical corticosteroids and calcineurin inhibitors for atopic eczema: systematic review and meta-analysis of randomized controlled trials

Schmitt, J.; von Kobyletzki, Laura LU ; Svensson, Åke LU and Apfelbacher, C. (2011) In British Journal of Dermatology 164(2). p.415-428
Abstract
P>Background Long-term low-level topical anti-inflammatory therapy has been suggested as a new paradigm in the treatment of atopic eczema (AE). Objectives To determine the efficacy and tolerability of topical corticosteroids and calcineurin inhibitors for flare prevention in AE. Methods Systematic review of randomized controlled trials reporting efficacy of topical corticosteroids and/or topical calcineurin inhibitors for flare prevention in AE. Identification of relevant articles by systematic electronic searches (Cochrane Library, Medline) supplemented by hand search. Primary efficacy endpoint: proportion of participants experiencing at least one flare during proactive anti-inflammatory treatment. Relative risks (RRs) and... (More)
P>Background Long-term low-level topical anti-inflammatory therapy has been suggested as a new paradigm in the treatment of atopic eczema (AE). Objectives To determine the efficacy and tolerability of topical corticosteroids and calcineurin inhibitors for flare prevention in AE. Methods Systematic review of randomized controlled trials reporting efficacy of topical corticosteroids and/or topical calcineurin inhibitors for flare prevention in AE. Identification of relevant articles by systematic electronic searches (Cochrane Library, Medline) supplemented by hand search. Primary efficacy endpoint: proportion of participants experiencing at least one flare during proactive anti-inflammatory treatment. Relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated and pooled by pharmaceutical agent using random-effects meta-analysis. Sensitivity analysis included meta-regression to explore the influence of study-specific covariates. Results Nine articles reporting on eight vehicle-controlled trials were included. Three, four and one trial(s) evaluated proactive therapy with topical tacrolimus, fluticasone propionate and methylprednisolone aceponate, respectively. Each agent under study was more efficacious to prevent flares than vehicle. Meta-analysis suggested that topical fluticasone propionate (RR 0 center dot 46, 95% CI 0 center dot 38-0 center dot 55) may be more efficacious to prevent disease flares than topical tacrolimus (RR 0 center dot 78, 95% CI 0 center dot 60-1 center dot 00). Meta-regression indicated robustness of these findings. Proactive anti-inflammatory therapy was generally well tolerated. The trials identified, however, do not allow firm conclusions about long-term safety. Conclusions Vehicle-controlled trials indicate efficacy of proactive treatment with tacrolimus, fluticasone propionate and methylprednisolone aceponate to prevent AE flares. Indirect evidence from vehicle-controlled trials suggests that twice weekly application of the potent topical corticosteroid fluticasone propionate may be more efficacious to prevent AE flares than tacrolimus ointment. Head to head trials should be conducted to confirm these results. Future studies are also needed to evaluate the long-term safety of proactive treatment of AE. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
British Journal of Dermatology
volume
164
issue
2
pages
415 - 428
publisher
Wiley-Blackwell
external identifiers
  • wos:000286668300027
  • scopus:79551491342
ISSN
1365-2133
DOI
10.1111/j.1365-2133.2010.10030.x
language
English
LU publication?
yes
id
ee65d103-a59c-4c9a-b618-0820642a39dd (old id 1876392)
date added to LUP
2011-04-01 11:59:36
date last changed
2017-11-05 03:01:53
@article{ee65d103-a59c-4c9a-b618-0820642a39dd,
  abstract     = {P>Background Long-term low-level topical anti-inflammatory therapy has been suggested as a new paradigm in the treatment of atopic eczema (AE). Objectives To determine the efficacy and tolerability of topical corticosteroids and calcineurin inhibitors for flare prevention in AE. Methods Systematic review of randomized controlled trials reporting efficacy of topical corticosteroids and/or topical calcineurin inhibitors for flare prevention in AE. Identification of relevant articles by systematic electronic searches (Cochrane Library, Medline) supplemented by hand search. Primary efficacy endpoint: proportion of participants experiencing at least one flare during proactive anti-inflammatory treatment. Relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated and pooled by pharmaceutical agent using random-effects meta-analysis. Sensitivity analysis included meta-regression to explore the influence of study-specific covariates. Results Nine articles reporting on eight vehicle-controlled trials were included. Three, four and one trial(s) evaluated proactive therapy with topical tacrolimus, fluticasone propionate and methylprednisolone aceponate, respectively. Each agent under study was more efficacious to prevent flares than vehicle. Meta-analysis suggested that topical fluticasone propionate (RR 0 center dot 46, 95% CI 0 center dot 38-0 center dot 55) may be more efficacious to prevent disease flares than topical tacrolimus (RR 0 center dot 78, 95% CI 0 center dot 60-1 center dot 00). Meta-regression indicated robustness of these findings. Proactive anti-inflammatory therapy was generally well tolerated. The trials identified, however, do not allow firm conclusions about long-term safety. Conclusions Vehicle-controlled trials indicate efficacy of proactive treatment with tacrolimus, fluticasone propionate and methylprednisolone aceponate to prevent AE flares. Indirect evidence from vehicle-controlled trials suggests that twice weekly application of the potent topical corticosteroid fluticasone propionate may be more efficacious to prevent AE flares than tacrolimus ointment. Head to head trials should be conducted to confirm these results. Future studies are also needed to evaluate the long-term safety of proactive treatment of AE.},
  author       = {Schmitt, J. and von Kobyletzki, Laura and Svensson, Åke and Apfelbacher, C.},
  issn         = {1365-2133},
  language     = {eng},
  number       = {2},
  pages        = {415--428},
  publisher    = {Wiley-Blackwell},
  series       = {British Journal of Dermatology},
  title        = {Efficacy and tolerability of proactive treatment with topical corticosteroids and calcineurin inhibitors for atopic eczema: systematic review and meta-analysis of randomized controlled trials},
  url          = {http://dx.doi.org/10.1111/j.1365-2133.2010.10030.x},
  volume       = {164},
  year         = {2011},
}