SYSTEMATIC REVIEW OF COMPARATIVE EFFICACY AND TOLERABILITY OF CALCIPOTRIOL

1. SYSTEMATIC REVIEW OF COMPARATIVE EFFICACY AND TOLERABILITY OF CALCIPOTRIOL Ashcroft, D. Po, ALW. Williams, HC. Griffiths,CEM. 2000. British Medical Journal 320: 963-967 Presented by Wislaine Coby

2. PURPOSE • Testing the new method of treatment which is calcipotriol (synthetic vitamin D analogue). • To see how effective calciptriol is, when compared to the other medications in treating psoriasis.

3. PSORIASIS • One of the most common skin diseases that affects more than 7 million adults and children. Its characterized by a build up of rough, dry, dead skin cells forming thick scales. The inflammation can be uncomfortable and painful. • The disease may persist for week, months, or years with periods of remission and recurrence. • There are no cures at all but there are treatments to reduce the degree and harshness of the conditions.

4. TYPES OF PSORIASIS • Erythrodermic: less common, characterized by red scales on the entire skin. This type makes temperature and fluid control difficult, placing a strain on internal organs. • Plaque: most common, characterized by raised, inflamed lesions covered with silver-white scales. Researchers will be focusing on this particular type.

5. CAUSE • The cause of psoriasis is unknown, although researchers believe that some type of stimulus triggers the abnormal cell growth in the epidermis. • Example: You cut yourself, the skin heals by regenerating the top layers. When the wound is healed, the process of regeneration stops. But with psoriasis skin cells continue to proliferate.

6. Factors that may trigger the wound healing process •Stress •Alcohol •Environmental factors such as exposure to chemicals •Injury to your skin •Immune system response to disease

7. •May be inherited, researchers are still conducting studies on how the gene is responsible for the disease• It is not contagious.

8. SIGNS AND SYMPTOMS • Swollen and stiff joints • Dry, red patches covered with silvery scales • Small scaling dots • Lesions • First you will notice red dotty spots that can be very small then slowly get larger, producing a silvery white surface scale that can easily shed. Patches spread over wide expanses of skin can lead to dry or cracking skin, swelling, intense itching and pain.

9. Psoriasis can occur anywhere on the body such as the knees, scalp, hands, and back. • Adults and children can develop the disease. Caucasians have the highest percentage at developing psoriasis and African American have a low incidence of the disease.

13. METHODS AND MATERIALS • 6038 patients with psoriasis were randomly selected for 37 trials. • Mean difference was used to determine the percent change in the severeness of the disease. • Rate ratio was used to determine the overall improvement of the medication. • Record adverse effects such as lesions, skin irritation and number of people who withdrew from the medications due to the adverse effects.

14. Calcipotriol: synthetic vitamin D analogue, induces terminal epidermal differentiation and inhibits epidermal proliferation without having any toxic effects. Most commonly used. Placebo: non-medicated substance, helps to relieve symptoms. Topical corticosteroids: has anti-inflammatory and anti-proliferative actions. Used to decrease inflammation and flatten plaques. TREATMENTS USED IN RESEARCH

15. Calcitriol: active vitamin D3 metabolite, an anti-proliferation • Coal tar: a toxic substance, reduce the size and redness of itchy patches • Short contact dithranol: a hydroxyanthrone which inhibits a variety of enzymes crucial to reducing epidermal proliferation. Also reduces the binding of the growth factors. • Tacalcitol: vitamin D3 analogue • Ultraviolet B: very therapeutic, an anti-proliferation

16. RESULTS Out of 37, 25 trials were not used because of duplication of reports, failure to meet criteria, and patient data could not be obtained.

17. TREATMENT Withdrawal Many patients withdrew from medication (33 of 48) because the disease was Resolved, meaning that treatment was found Withdrew from treatment with high potent Corticosteroids.

18. ADVERSE EFFECTS • Patients developed lesions and skin irritation. • Using ditranol caused more lesions

19. Figure 1

20. RATIONALE • Treatment was more effective with the 8 week period than the 6 week period because treatment seemed to make adverse effects show less. • Research shows calcipotriol was favored more in treating psoriasis.

21. Sensitivity analysis (95% confidence intervals) of type of patients treated in placebo controlled trials at eight weeks

22. CONCLUSION •Calcipotriol is indeed an effective drug to treat mild to moderate psoriasis. Although it may cause skin irritation, this drug can still be used. It is more effective than the other medications. •Calcipotriol works even better with corticosteroid, causing less skin irration.

23. REFERENCES • Fredriksson, t. Petterson, U. 1978. Severe psoriasis—oral therapy with a new retinoid. Dermatoligica 157:238-244 • Guttman, C. 2000. Emollient base delivers topical corticosteriods with better efficacy. Dermatology Time 21: 33 • Martin, D. 1998. Journal of Dermatological Treatment 9: 1-6 • Bark, J. 1995. Psoriasis. Your Skin: An Owner’s Guide 157-169