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Vitamin D plus steroids helps psoriasis 2X more than vitamin D – meta-analysis May 2012

Topical vitamin D analogues alone or in association with topical steroids for psoriasis: a systematic review

S Devaux1, devaux.s at chu-toulouse.fr, A. Castela2, E Archier3, A Gallini4, P. Joly5, L. Misery6, S. Aractingi7, F. Aubin8, H. Bachelez9, B. Cribier10, D. Jullien11, M. Le Maître12, M.-A. Richard3, J.-P. Ortonne2, C. Paul1
1 Dermatology Department, Paul Sabatier University, Toulouse
2 Dermatology Department, Nice University, L’Archet II Hospital, Nice
3 UMR 911, INSERM CRO2 and Dermatology Department, Timone Hospital, Aix-Marseille University, Marseille
4 UMR 1027 INSERM, Paul Sabatier University, Toulouse
5 Dermatology Department, INSERM U 905, Rouen Charles Nicolle Hospital, University of Rouen
6 Dermatology Department, Brest University Hospital, Brest
7 Dermatology Department, Tenon Hospital, APHP and Paris 6 University, Paris
8 Dermatology Department, Franche Comté University, Besançon
9 Dermatology Department, Saint-Louis Hospital, Paris
10 Dermatology Department, University Hospital, Strasbourg
11 Dermatology Department, Edouard Herriot Hospital, Lyon, and
12 Dermatologist, Caen, France
Article first published online: 18 APR 2012

2012 European Academy of Dermatology and Venereology
Journal of the European Academy of Dermatology and Venereology

Special Issue: Evidence-based Recommendations on Topical Treatment and Phototherapy of Psoriasis:

Systematic Review and Expert Opinion of a Panel of Dermatologists

Volume 26, Issue Supplement s3, pages 52–60, May 2012

Objective? The objective of this systematic review was to prepare for evidence-based recommendations on the use of vitamin D analogues, and their combination with topical steroids in psoriasis.

Methods? Literature systematic review performed in May 2011. The Cochrane, PubMed and Embase databases were systematically searched with different combinations: including Psoriasis AND calcipotriol expanded to all vitamin D analogues. To assess efficacy across studies, we used two predefined criteria to account for the numerous endpoints found in the literature, ‘Treatment success’ corresponding to 90% improvement in severity and ‘Satisfactory response’ corresponding to 75% improvement. We conducted a meta-analysis comparing the efficacy of vitamin D analogues plus topical steroids (VDS) vs. vitamin D analogues alone (VD). To determine the relative cost-efficacy of the topical drugs available on the market, cost/efficacy ratios were calculated for each product according to the approved therapeutic regimen.

Results? 51 articles were selected. The application duration varied between three to 52 weeks across studies.
VD as monotherapy had a satisfactory response rate between 22% to 96% and a treatment success rate ranging from 4% to 40%.
VDS had a satisfactory response rate between 35% to 86% and a treatment success rate ranging from 27% to 53%.

A meta-analysis found a probability of success twice higher with VDS than with VD in adult plaque psoriasis.
The cost/efficacy ratio was evaluated as 1.2–1.8 times higher for VDS than for VD.

Conclusion? VDS is twice more effective than VD and displays a better cost per success.
Additional studies are needed to clarify maintenance treatment, impact on quality of life, treatment of non-plaque psoriasis.
It will be important to harmonize outcome measures in future studies with topical agents in psoriasis to better appraise their efficacy.
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Wonder if this meta-analysis considered:

  1. How much vitamin D was used in each trial (many meta-analysis treat 400 IU the same as 4,000 IU)
  2. How long each trial was (3 to 52 weeks)
  3. How much vitamin D the people in each trial already had
  4. How much sunlight the people in the trial got
  5. The combination of Vitamin D and UVB - which seems excellent

See also VitaminDWiki

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