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Keywords:

  • atopic dermatitis;
  • efficacy;
  • long-term treatment;
  • randomized controlled trial;
  • safety;
  • 0·1% tacrolimus

Summary

Background  Atopic dermatis (AD) is a chronic disease that often requires long-term treatment. Topical corticosteroids are the usual therapy for patients with AD, but prolonged usage can result in skin atrophy and other side-effects.

Objectives  In a randomized, double-blind, comparative study, to compare the efficacy and safety of a 6-month treatment period with 0·1% tacrolimus ointment vs. a corticosteroid ointment regimen in adults with moderate to severe AD.

Methods  Treatment was applied twice daily for a maximum of 6 months. Patients in the tacrolimus treatment group (n = 487) applied 0·1% tacrolimus ointment to all affected areas over the whole body. The patients treated with the corticosteroid regimen (n = 485) applied 0·1% hydrocortisone butyrate ointment to affected areas on the trunk and extremities and 1% hydrocortisone acetate ointment to affected areas on the face and neck. The study primary endpoint was the response rate, i.e. the proportion of patients with at least 60% improvement in the modified Eczema Area and Severity Index (mEASI) between baseline and month 3.

Results  By month 3, more patients in the 0·1% tacrolimus group responded to treatment (72·6% vs. 52·3% in the corticosteroid group, P < 0·001). The patients treated with 0·1% tacrolimus also showed greater improvement in mEASI, EASI, affected body surface area and physician and patient assessments of global response. Patients applying 0·1% tacrolimus ointment experienced more skin burning (52·4% vs. 13·8% in the corticosteroid group; P < 0·001). In most patients, skin burning was mild to moderate in severity and decreased rapidly after the first week of treatment. There was no increase in the incidence of infections or malignancies over time in either treatment group.

Conclusions  Long-term treatment with 0·1% tacrolimus ointment is significantly more efficacious than a corticosteroid ointment regimen in adults with moderate to severe AD.