Calcipotriol, a
vitamin D3 analog, acts not only to inhibit cell proliferation and enhance cell differentiation in the skin of patients with
psoriasis, but also appears to have effects on
immunologic markers that are thought to play a role in the etiology of the disease. In several well designed, short term studies in adults,
calcipotriol ointment 50 micrograms/g twice daily provided similar or superior efficacy to several other antipsoriatic agents in adult patients with mild to moderate
psoriasis. In patients with nonscalp
psoriasis, the drug provided superior efficacy to twice daily placebo (vehicle
ointment), twice daily
fluocinonide 500 micrograms/g, once daily
tacalcitol 4 micrograms/g and twice daily
coal tar 5% plus
allantoin 2% and
hydrocortisone 0.5%. Furthermore,
calcipotriol therapy generally provided superior efficacy to twice daily
betamethasone valerate 1 to 1.2 mg/g or once daily
dithranol 1 to 20 mg/g, and similar efficacy to twice daily
betamethasone dipropionate plus
salicylic acid or once daily
maxacalcitol 6 to 50 micrograms/g. Limited data indicated that
calcipotriol ointment 50 micrograms/g also improved overall disease severity in children. In combination with other antipsoriatic agents [
acitretin,
cyclosporine,
betamethasone valerate,
halobetasol (
ulobetasol)], ultraviolet B or
psoralen ultraviolet A (PUVA)
phototherapy,
calcipotriol ointment 50 micrograms/g twice daily improved the beneficial effects of these drugs on overall disease severity in adult patients with moderate to severe
psoriasis. Furthermore, in separate trials,
calcipotriol combination
therapy reduced the dosage of
acitretin required to achieve clearance of
psoriasis and the duration of PUVA and dosage of UVA
phototherapy, potentially improving the benefit/risk ratio for these other antipsoriatic treatments.
Calcipotriol was generally well tolerated in short and long term studies in adult patients, with the majority of adverse events being mild to moderate in intensity and transient. The most common adverse events associated with
calcipotriol therapy were dermatologic in nature and included lesional or perilesional irritations, face and scalp irritations, worsening of
psoriasis and miscellaneous dermatologic events. Notably, there have been very few reports of patients developing
hypercalcemia or
hypercalciuria during
calcipotriol therapy, with most occurring in patients who exceeded the recommended dosage of 100 g/week. Although data in children are limited, the drug was well tolerated with the nature and incidence of adverse effects similar to those observed in adult patients.
CONCLUSIONS: Extensive clinical experience, along with several short and long term clinical trials, has shown
calcipotriol ointment to be an effective and well tolerated topical agent in adult patients with
psoriasis. In addition,
calcipotriol ointment proved beneficial in combination with other topical,
phototherapy or systemic antipsoriatic treatments, reducing the dosage and/or duration of some of these treatments and potentially improving their benefit/risk ratio.
Calcipotriol ointment is valuable as a first- or second-line
therapy option for the management of mild to moderate
psoriasis and in combination with other antipsoriatic agents for more severe
psoriasis.