+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendations



Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendations



Paediatric Drugs 15(4): 303-310



Atopic dermatitis (AD) is an inflammatory skin disease commonly affecting children and managed by pediatricians, primary care physicians, allergists, and dermatologists alike. For many years, the only available topical pharmacological treatment was topical corticosteroids. This changed in 2000-2001, when topical formulations of two calcineurin inhibitors (tacrolimus and pimecrolimus) were approved for short-term or chronic intermittent treatment of AD in patients ≥ 2 years of age, in whom other treatments have been ineffective or contraindicated. These topical calcineurin inhibitors (TCIs) quickly became a popular treatment option due at least in part to concerns over adverse events associated with prolonged topical corticosteroid use, especially in children. However, based on theoretical concerns about a possible risk of lymphoma associated with TCI use, a Boxed Warning was placed on both products in 2006. Since then, despite an extensive body of evidence, no causal relationship has been demonstrated between TCI use and an increased risk of lymphoma; however, the US FDA has concluded that a link cannot be ruled out. In fact, based on post-marketing surveillance of spontaneous, literature, and solicited reports, we report here that the lymphoma incidence in the topical pimecrolimus-exposed population is up to approximately 54-fold less than that seen in the general US population. This review summarizes the mechanism of action of TCIs, the factors that prompted the Boxed Warning, and recent TCI safety and efficacy data. Based on these data, both topical corticosteroids and TCIs should have defined roles in AD management, with TCIs favored for sensitive skin areas (e.g., face) and instances where topical corticosteroids have proven ineffective, thereby minimizing the risk of adverse effects with both drug classes.

(PDF emailed within 0-6 h: $19.90)

Accession: 036833260

Download citation: RISBibTeXText

PMID: 23549982

DOI: 10.1007/s40272-013-0013-9


Related references

Topical corticosteroids and topical calcineurin inhibitors in the treatment of atopic dermatitis: focus on percutaneous absorption. American Journal of Therapeutics 16(3): 264-273, 2009

Use of topical corticosteroids and topical calcineurin inhibitors for the treatment of atopic dermatitis in thin and sensitive skin areas. Current Medical Research and Opinion 24(4): 985-994, 2008

Topical Calcineurin Inhibitors in the Treatment of Atopic Dermatitis. American Journal of Clinical Dermatology 5(4): 267-279, 2004

Systematic review of published trials: long-term safety of topical corticosteroids and topical calcineurin inhibitors in pediatric patients with atopic dermatitis. Bmc Pediatrics 16: 75, 2017

The treatment of atopic dermatitis in adults with topical calcineurin inhibitors. Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete 54(5): 424-431, 2003

Safety of topical calcineurin inhibitors for the treatment of atopic dermatitis. PharmacoTherapy 27(7): 1020-1028, 2007

Topical calcineurin inhibitors in atopic dermatitis: a systematic review and meta-analysis. Journal of Dermatological Science 54(2): 76-87, 2009

Systematic review and meta-analysis of randomized clinical trials (RCTs) comparing topical calcineurin inhibitors with topical corticosteroids for atopic dermatitis: A 15-year experience. Journal of the American Academy of Dermatology 75(2): 410-419.E3, 2017

Immunomodulation and safety of topical calcineurin inhibitors for the treatment of atopic dermatitis. Dermatology 211(2): 174-187, 2005

A safety assessment of topical calcineurin inhibitors in the treatment of atopic dermatitis. Medgenmed 8(4): 8, 2007

Efficacy and economics of topical calcineurin inhibitors for the treatment of atopic dermatitis. American Journal of Clinical Dermatology 7(4): 213-222, 2006

Calcineurin inhibitors in treatment of atopic dermatitis. Topical corticoids now only in severe outbreaks?. Mmw Fortschritte der Medizin 145(29-30): 62-62, 2003

Topical calcineurin inhibitors in the treatment of atopic dermatitis - an update on safety issues. Journal der Deutschen Dermatologischen Gesellschaft 10(3): 167-172, 2013

Safety and efficacy of topical calcineurin inhibitors in the treatment of childhood atopic dermatitis. American Journal of Clinical Dermatology 6(2): 65-77, 2005

Systematic review on the efficacy, safety, and cost-effectiveness of topical calcineurin inhibitors in atopic dermatitis. Dermatitis 26(3): 122-132, 2016