SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

9/9/04

Comparative efficacy of tacrolimus and pimecrolimus in the treatment of atopic dermatitis

Summary
Background - Tacrolimus (Tac) and pimecrolimus (Pim) are two calcineurin inhibiting immunosuppressive/anti-inflammatory agents now being used extensively in topical treatment approaches in atopic dermatitis (AD). But what is the comparative efficacy of Tac and Pim in such treatment?

Findings - Iskedjian et al of Pharmideas Consulting in Oakville, Canada reviewed all randomized clinical trials (RCT) of the efficacy of topical Tac and Pim treatment in AD as defined by the percentage reduction from pre-treatment status in the Eczema Area and Severity Index (EASI). They found 15 studies involving 5,301 patients which met their quality criteria for inclusion. They concluded that success rates during Tac and Pim therapy were not significantly different (e.g. 60-70% mean reductions in the EASI at 3-6 months). However, success rates with Tac treatment were consistently higher than with Pim therapy even though Tac tended to be used more commonly in those with more severe AD. A RCT comparing Tac and Pim topical treatments head-to-head in AD patients would be needed for a more definitive conclusion.

Reference
Am J Clin Dermatol 2004;5:267-79

Editor's Comments
The findings in this analysis are similar to the impression I have received after reading reports of several of the RCT in this area of investigarion. Topical Tac treatment appears to be more potent than topical Pim therapy in AD. However, the incidence of local adverse effects at the application site (burning, stinging) may be somewhat higher with Tac than with Pim therapy. Yet, these topical adverse effects are generally transient.

 

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