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A systematic review of tacrolimus ointment compared with corticosteroids in the treatment of atopic dermatitis.
Curr Med Res Opin 2011; 27(7):1395-406CM

Abstract

OBJECTIVE

A systematic review and meta-analysis was conducted to determine the efficacy and tolerability of tacrolimus ointment for the treatment of atopic dermatitis (AD) compared with topical corticosteroids.

METHODS

Electronic searches were performed in Medline, Embase and the Cochrane Library, as well as relevant conference proceedings. Two researchers independently selected trials investigating the efficacy and/or safety of tacrolimus ointment in the treatment of AD. No language restrictions were applied. Relevant outcome data from included trials were extracted by two independent reviewers. Direct meta-analysis to calculate relative risks (RR) (95% confidence intervals (CIs)) was conducted on dichotomous efficacy/safety outcomes of interest.

RESULTS

Seventeen trials comparing tacrolimus ointment with topical corticosteroids in both paediatric (n = 2328) and adult (n = 2849) patients were identified. No studies comparing tacrolimus ointment with class IV topical corticosteroids were identified. Tacrolimus 0.1% ointment was found to be of similar efficacy to class I/II and class III topical corticosteroids. In three individual trials (comparing tacrolimus 0.1% ointment to a topical corticosteroid), evaluation of the Physician's Global Evaluation of Clinical Response (PGECR) resulted in RRs of 0.95 (95% CI 0.78-1.16), 3.09 (95% CI 2.14-4.45) and 1.35 (95% CI 0.86-2.12), where values above one favour tacrolimus ointment. With the exception that tacrolimus ointment caused more skin burning than comparator treatments (tacrolimus 0.03% versus a class III topical corticosteroid, the RR was 3.00 (95% CI 1.21-7.43) in favour of the corticosteroid), no significant differences with regards to side-effects and withdrawals due to AEs were found. Quality of life data were reported in two studies. While one study reported greater improvements in tacrolimus-treated adult patients compared with topical steroids, the second reported greater improvements in paediatric patients treated with steroids compared with tacrolimus ointment.

CONCLUSIONS

The current review and meta-analysis showed tacrolimus ointment to be of similar efficacy to corticosteroids. The interpretation of available data is limited by heterogeneity in outcome measures between trials. Further trials are needed to assess the impact of treatments on patient reported outcomes.

Authors+Show Affiliations

Department of Dermatology, Institute of Clinical Research in Malmö, Skåne University Hospital, Lund University, SE 205 02 Malmö.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

21563877

Citation

Svensson, A, et al. "A Systematic Review of Tacrolimus Ointment Compared With Corticosteroids in the Treatment of Atopic Dermatitis." Current Medical Research and Opinion, vol. 27, no. 7, 2011, pp. 1395-406.
Svensson A, Chambers C, Gånemo A, et al. A systematic review of tacrolimus ointment compared with corticosteroids in the treatment of atopic dermatitis. Curr Med Res Opin. 2011;27(7):1395-406.
Svensson, A., Chambers, C., Gånemo, A., & Mitchell, S. A. (2011). A systematic review of tacrolimus ointment compared with corticosteroids in the treatment of atopic dermatitis. Current Medical Research and Opinion, 27(7), pp. 1395-406. doi:10.1185/03007995.2011.582483.
Svensson A, et al. A Systematic Review of Tacrolimus Ointment Compared With Corticosteroids in the Treatment of Atopic Dermatitis. Curr Med Res Opin. 2011;27(7):1395-406. PubMed PMID: 21563877.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A systematic review of tacrolimus ointment compared with corticosteroids in the treatment of atopic dermatitis. AU - Svensson,A, AU - Chambers,C, AU - Gånemo,A, AU - Mitchell,S A, Y1 - 2011/05/12/ PY - 2011/5/14/entrez PY - 2011/5/14/pubmed PY - 2011/11/2/medline SP - 1395 EP - 406 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 27 IS - 7 N2 - OBJECTIVE: A systematic review and meta-analysis was conducted to determine the efficacy and tolerability of tacrolimus ointment for the treatment of atopic dermatitis (AD) compared with topical corticosteroids. METHODS: Electronic searches were performed in Medline, Embase and the Cochrane Library, as well as relevant conference proceedings. Two researchers independently selected trials investigating the efficacy and/or safety of tacrolimus ointment in the treatment of AD. No language restrictions were applied. Relevant outcome data from included trials were extracted by two independent reviewers. Direct meta-analysis to calculate relative risks (RR) (95% confidence intervals (CIs)) was conducted on dichotomous efficacy/safety outcomes of interest. RESULTS: Seventeen trials comparing tacrolimus ointment with topical corticosteroids in both paediatric (n = 2328) and adult (n = 2849) patients were identified. No studies comparing tacrolimus ointment with class IV topical corticosteroids were identified. Tacrolimus 0.1% ointment was found to be of similar efficacy to class I/II and class III topical corticosteroids. In three individual trials (comparing tacrolimus 0.1% ointment to a topical corticosteroid), evaluation of the Physician's Global Evaluation of Clinical Response (PGECR) resulted in RRs of 0.95 (95% CI 0.78-1.16), 3.09 (95% CI 2.14-4.45) and 1.35 (95% CI 0.86-2.12), where values above one favour tacrolimus ointment. With the exception that tacrolimus ointment caused more skin burning than comparator treatments (tacrolimus 0.03% versus a class III topical corticosteroid, the RR was 3.00 (95% CI 1.21-7.43) in favour of the corticosteroid), no significant differences with regards to side-effects and withdrawals due to AEs were found. Quality of life data were reported in two studies. While one study reported greater improvements in tacrolimus-treated adult patients compared with topical steroids, the second reported greater improvements in paediatric patients treated with steroids compared with tacrolimus ointment. CONCLUSIONS: The current review and meta-analysis showed tacrolimus ointment to be of similar efficacy to corticosteroids. The interpretation of available data is limited by heterogeneity in outcome measures between trials. Further trials are needed to assess the impact of treatments on patient reported outcomes. SN - 1473-4877 UR - https://www.unboundmedicine.com/medline/citation/21563877/A_systematic_review_of_tacrolimus_ointment_compared_with_corticosteroids_in_the_treatment_of_atopic_dermatitis_ L2 - http://www.tandfonline.com/doi/full/10.1185/03007995.2011.582483 DB - PRIME DP - Unbound Medicine ER -