Los corticoides topicos siguen siendo los tratamientos con mayor nivel de evidencia en el manejo de la Dermatitis atopica.

Las opciones terapeuticas para el tratamiento de los pacientes con dermatitis atópica no son muchas, pero el miedo a los corticoides ocurre por nuestra falta de información sobre el uso correcto de los mismos a los padres de pacientes y pacientes, pero los inhibidorss topicos de calcineurina demuestran gran eficacia tambien.

Systematic review and meta-analysis of randomized clinical trials (RCTs) comparing topical calcineurin inhibitors with topical corticosteroids for atopic dermatitis: A 15-year experience

Joris A. Broeders

, MD, PhD

, 

Usama Ahmed Ali

, MD

, 

Gayle Fischer

, MD

Published Online: May 11, 2016

DOI: http://dx.doi.org/10.1016/j.jaad.2016.02.1228

Publication stage: In Press Corrected Proof

Article Infoclick to expand contents 

Background

Calcineurin inhibitors are alternatives to corticosteroid for treatment of atopic dermatitis.

Objectives

We sought to compare the beneficial effects and adverse events associated with these therapies in treating patients with atopic dermatitis.

Methods

Four databases were searched for randomized clinical trials comparing topical calcineurin inhibitors versus corticosteroids in children and adults. Methodological quality was evaluated to assess bias risk. Clinical outcome and costs were compared.

Results

Twelve independent randomized clinical trials comparing calcineurin inhibitors (n = 3492) versus corticosteroids (n = 3462) were identified. Calcineurin inhibitors and corticosteroids had similar rates of improvement of dermatitis (81% vs 71%; risk ratio [RR] 1.18; 95% confidence interval [CI] 1.04-1.34; P = .01) and treatment success (72% vs 68%; RR 1.15; 95% CI 1.00-1.31; P = .04). Calcineurin inhibitors were associated with higher costs and had more adverse events (74% vs 64%; RR 1.28; 95% CI 1.05-1.58; P = .02) including a higher rate of skin burning (30% vs 9%; RR 3.27; 95% CI 2.48-4.31; P < .00001) and pruritus (12% vs 8%; RR 1.49; 95% CI 1.24-1.79; P < .00001). There were no differences in atrophy, skin infections, or adverse events that were serious or required discontinuation of therapy.

Limitations

Only a small number of trials reported costs.

Conclusion

Calcineurin inhibitors and corticosteroids have similar efficacy. Calcineurin inhibitors are associated with higher costs and have more adverse events, such as skin burning and pruritus. These results provide level-1a support for the use of corticosteroids as the therapy of choice for atopic dermatitis.

Key words:

atopic dermatitis, calcineurin inhibitors, corticosteroids, meta-analysis, randomized controlled trial, systematic review

Abbreviations used:

CI (confidence interval), FDA (Food and Drug Administration), RCT (randomized clinical trial), RR (risk ratio)

Funding sources: None.

Conflicts of interest: None declared.

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

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