Efficacy and tolerability of proactive treatment with topical corticosteroids and calcineurin inhibitors for atopic eczema: systematic review and meta-analysis of randomized controlled trials
- 23 November 2010
- journal article
- research article
- Published by Oxford University Press (OUP) in British Journal of Dermatology
- Vol. 164 (2), 415-428
- https://doi.org/10.1111/j.1365-2133.2010.10030.x
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.This publication has 35 references indexed in Scilit:
- Core Outcome Domains for Controlled Trials and Clinical Recordkeeping in Eczema: International Multiperspective Delphi Consensus ProcessJournal of Investigative Dermatology, 2011
- Infant-onset eczema in relation to mental health problems at age 10 years: Results from a prospective birth cohort study (German Infant Nutrition Intervention plus)Journal of Allergy and Clinical Immunology, 2010
- Three Times Weekly Tacrolimus Ointment Reduces Relapse in Stabilized Atopic Dermatitis: A New Paradigm for UsePEDIATRICS, 2008
- Reduction of relapses of atopic dermatitis with methylprednisolone aceponate cream twice weekly in addition to maintenance treatment with emollient: a multicentre, randomized, double-blind, controlled studyBritish Journal of Dermatology, 2008
- What are the best outcome measurements for atopic eczema? A systematic reviewJournal of Allergy and Clinical Immunology, 2007
- Skin barrier function, epidermal proliferation and differentiation in eczemaJournal of Dermatological Science, 2006
- Atopic DermatitisThe New England Journal of Medicine, 2005
- Topical corticosteroids in atopic dermatitisBMJ, 2003
- Atopic dermatitisThe Lancet, 2003
- Clinical Validation and Guidelines for the SCORAD Index: Consensus Report of the European Task Force on Atopic DermatitisDermatology, 1997