SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

11/2/04

Comparison of tacrolimus and pimecrolimus treatment in moderate atopic dermatitis of childhood

Summary
Background - Tacrolimus (Tac) and Pimecrolimus (Pim) are different calcineurin inhibitor used in the topical treatment of atopic dermatitis (AD). A recent systematic review (Am J Clin Dermatol 2004;5:267-79) pointed out that the efficacy of Tac and Pim in AD treatment was not significantly different (60-70%) when compared to placebo although such efficacy tended to be higher with Tac use, even though Tac treated patients tended to have more severe AD. A head-to-head comparison of Tac and Pim was recommended.

Findings - Kempers et al in multiple institutions have carried out such a comparison in an investigator-blinded parallel group study of 141 subjects (ages 2-17 years) with moderate AD, randomized (using a validated telephone system) to receive either Tac ointment 0.03% or Pim cream 1% applied b.i.d. Sequential evaluations were made during the 6 week study period.

By day 43, the efficacy of Tac and Pim, as assessed by the Investigator's Global Assessment (IGA) was not significantly different although pruritus may have been reduced more by Tac treatment at some time points. As determined by questionnaires completed by patients or parents, local application site adverse reactions, particularly local itching were less common and/or of shorter duration with Pim than with Tac treatment. More patients preferred the Pim formulation than the Tac formulation.

Reference
J Am Acad Dermatol 2004;51:515-25

Editor's Comments
Previous studies comparing Tac or Pim to placebo topical treatment have generally concluded that Pim appears to cause less frequent/prolonged application site adverse reactions than does Tac. As noted above, the overall efficacy of Tac and Pim treatment is not strikingly different but tends to be higher with Tac use, particularly in more severe AD. It is somewhat difficult to compare the efficacy assessments used in the previous studies (generally an EASI score) with the IGA used in the study described above.

It is not surprising that patients preferred the cream formulation of Pim to the more greasy ointment-based Tac. It should be mentioned that considerable effort was made to attempt blinding of the investigators as to which topical product was used. However, it would have been preferable if a "double dummy" approach was used in which a bland ointment was applied with Pim cream and bland cream with the Tac ointment. It should also be mentioned that the manufacturers of Pim sponsored this study.

 

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