Calcipotriol (Dovonex), a synthetic vitamin D3 derivative, has efficacy comparable to that of potent topical corticosteroids for the treatment of mild-to-moderate chronic plaque psoriasis. This is the finding of a review of randomised, controlled trials of treatment of the disorder that was undertaken by Dr Darren Ashcroft (Centre for Evidence-based Pharmacotherapy, Aston university) and colleagues.
Dr Ashcroft et al reviewed 37 trials involving 6,038 patients being treated for mild-to-moderate psoriasis with a variety of agents. These included potent topical corticosteroids, calcitriol, coal tars, dithranol and 0.005 per cent calcipotriol cream or ointment.
The investigators found that six to eight weeks after the start of treatment, calcipotriol was more effective than calcitriol, coal tar, a combination of coal tar, allantoin and hydrocortisone, "short contact" dithranol, tacalcitol and placebo. In addition, calcipotriol was significantly more effective than potent topical corticosteroids at week six but as effective at eight weeks. The most commonly observed adverse event was skin irritation.
Calcipotriol is licensed for use once or twice daily but the investigators found that it was more effective when applied twice daily. However, they say that once daily use together with a potent topical corticosteroid might be more effective and better tolerated than twice daily calcipotriol. They suggest that this may be because the corticosteroids suppress any irritation caused by calcipotriol (British Medical Journal 2000;320:963).