Tcis en Vitiligo

Treatment Outcomes of Topical Calcineurin Inhibitor Therapy for Patients With Vitiligo

JAMA Dermatology

TAKE-HOME MESSAGE

• A total of 46 studies (1499 patients) were evaluated to determine the treatment response to topical calcineurin inhibitors (TCI) in vitiligo. Mild response (>25% repigmentation) was achieved by 55.0% of 560 patients in 21 studies, at least moderate response (>50% repigmentation) in 38.5% of 619 patients in 23 studies, and a marked response (>75% repigmentation) in 18.1% of 520 patients in 19 studies. In 5 studies evaluating 162 children, a marked response to TCI monotherapy was seen in 31.7%, and at least a mild response was seen in 66.4%. Of the 12 studies combining TCI and phototherapy, narrow-band UVB was used in 10, and excimer laser in 2. At least a mild response was achieved in 89.5% of 433 patients in 8 studies, at least moderate response in 72.9% of 486 patients in 10 studies, and marked response was achieved in 47.5% of 490 patients in 9 studies. No studies reported adverse effects leading to discontinuation of treatment.

• TCI monotherapy was associated with a favorable treatment response rate, especially in lesions on the face and neck and in children, and TCI combined with phototherapy appears to produce a synergistic effect.

– Caroline K. Crabtree, MD

Abstract

IMPORTANCE

Topical calcineurin inhibitors (TCIs), including tacrolimus and pimecrolimus, have been widely used for the treatment of vitiligo; however, the efficacy of TCI monotherapy is often underestimated.

OBJECTIVES

To estimate the treatment responses to both TCI monotherapy and TCI accompanied by phototherapy for vitiligo, based on relevant prospective studies, and to systematically review the mechanism of action of TCIs for vitiligo treatment.

DATA SOURCES

A comprehensive search of the MEDLINE, Embase, Web of Science and Cochrane Library databases from the date of database inception to August 6, 2018, was conducted. The main key words used were vitiligo, topical calcineurin inhibitor, tacrolimus, pimecrolimus, and FK506.

STUDY SELECTION

Of 250 studies initially identified, the full texts of 102 articles were assessed for eligibility. A total of 56 studies were identified: 11 studies on the TCI mechanism, 36 studies on TCI monotherapy, 12 studies on TCI plus phototherapy, and 1 study on TCI maintenance therapy.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data on study design, patients, intervention characteristics, and outcomes. Random-effects meta-analyses using the generic inverse variance weighting were performed for the TCI monotherapy and TCI plus phototherapy groups.

MAIN OUTCOMES AND MEASURES

The primary outcomes were the rates of at least mild (≥25%), at least moderate (≥50%), and marked (≥75%) repigmentation responses to treatment. These rates were calculated by dividing the number of participants in an individual study who showed the corresponding repigmentation by the total number of participants who completed that study.

RESULTS

In the 56 studies included in the analysis, 46 (1499 patients) were selected to evaluate treatment response. For TCI monotherapy, an at least mild response was achieved in 55.0% (95% CI, 42.2%-67.8%) of 560 patients in 21 studies, an at least moderate response in 38.5% (95% CI, 28.2%-48.8%) of 619 patients in 23 studies, and a marked response in 18.1% (95% CI, 13.2%-23.1%) of 520 patients in 19 studies after median treatment duration of 3 months (range, 2-7 months). In the subgroup analyses, face and neck lesions showed an at least mild response in 73.1% (95% CI, 32.6-83.5%) of patients, and a marked response in 35.4% (95% CI, 24.9-46.0%) of patients. For TCI plus phototherapy, an at least mild response to TCI plus phototherapy was achieved in 89.5% (95% CI, 81.1-97.9%) of patients, and a marked response was achieved in 47.5% (95% CI, 30.6-64.4%) of patients.

CONCLUSIONS AND RELEVANCE

The use of TCIs, both as a monotherapy and in combination with phototherapy, should be encouraged in patients with vitiligo.

JAMA Dermatology

Treatment Outcomes of Topical Calcineurin Inhibitor Therapy for Patients With Vitiligo: A Systematic Review and Meta-Analysis

JAMA Dermatol 2019 May 29;[EPub Ahead of Print], JH Lee, HS Kwon, HM Jung, H Lee, GM Kim, HW Yim, JM Bae 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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