The Evolution Of Cal/BD Fixed Dose Combination Therapy For Psoriasis: A Case Study And Discussion
Abstract
Psoriasis is a chronic, immune-mediated, genetic inflammatory skin disease that occurs in 2-3% of the Canadian population, which is comparable in incidence and prevalence to Europe and the USA. It begins in childhood in almost a third of patients and the prevalence increases in a linear pattern from age 1 to age 18. The incidence continues to increase from the 2nd decade reaching a peak in the latter half of the 6th decade. The global incidence of psoriasis has increased over the past 30 years in both adults and children, especially in North America and Western Europe. As illustrated in this case, psoriasis is associated with comorbidities, such as hypertension, obesity, impaired glucose tolerance, hyperlipidemia, arthritis, and inflammatory bowel disease. These comorbidities occur in twice as many patients under the age of 20 with psoriasis as those without.
The first line of treatment for mild-to-moderate psoriasis is topical therapy, which also complements systemic therapies in more severe disease.
References
Dogra S, Kaur I. Childhood psoriasis. Indian J Dermatol Venereol Leprol. 2010;76:357-65.
Rasmussen GS, Kragballe K, Maindal HT, Lomborg K. Caring for young people with moderate to severe psoriasis: an interpretive description of parental perspectives, Journal of Dermatological Treatment. 2020;31(3);227-234. DOI:10.1080/0954663 4.2019.1590523.
Eder L, Widdifield J, Rosen CF, et al. Trends in the Prevalence and Incidence of Psoriasis and Psoriatic Arthritis in Ontario, Canada: A Population-Based Study. Arthritis Care Res (Hoboken). 2019 Aug;71(8):1084-1091. doi: 10.1002/ acr.23743. Epub 2019 Jul 11. PMID: 30171803.
Augustin M, Glaeske G, Radtke MA, Christophers E, Reich K, Schafer I. Epidemiology and comorbidity of psoriasis in children. Br J Dermat. 2010;162(3):633–6.
AlQassimi, et al. Global burden of psoriasis – comparison of regional and global epidemiology. 1990 to 2017 International Journal of Dermatology. 2020;59:566–571.
Tollefson MM, Crowson CS, McEvoy MT, Maradit Kremers H. Incidence of psoriasis in children: a population-based study. J Am Acad Dermatol. 2010;62(6):979–87.
Augustin M, Glaeske G, Radtke MA, Christophers E, Reich K, Schafer I. Epidemiology and comorbidity of psoriasis in children. Br J Dermat. 2010;162(3):633–6.
Segaert S, Shear NH, Chiricozzi A, et al. Optimizing Anti-Inflammatory and Immunomodulatory Effects of Corticosteroid and Vitamin D Analogue Fixed-Dose Combination Therapy. Dermatol Ther (Heidelb). 2017;7(3):265-279. doi:10.1007/ s13555-017-0196-z.
Norsgaard H, Kurdykowski S, Descargues P, et al. Calcipotriol counteracts betamethasone-induced decrease in extracellular matrix components related to skin atrophy. Arch Dermatol Res. 2014;306:719–729.
Douglas WS, Poulin Y, Decroix J, et al.A New Calcipotriol/Betamethasone Formulation with Rapid onset of Action was Superior to Monotherapy with Betamethasone Dipropionate or Calcipotriol in Psoriasis VulgarisActa Derm Venereol. 2002;82:131–135.
Kaufmann R, Bibby AJ, Bissonnette R, et al. A new calcipotriol/betamethasone dipropionate formulation (Daivobet) is an effective once-daily treatment for psoriasis vulgaris. Dermatology. 2002;205(4):389-93. doi: 10.1159/000066440. PMID: 12444337.
Van Geel MJ, Mul K, Oostveen AM, et al. Calcipotriol/betamethasone dipropionate ointment in mild-to-moderate paediatric psoriasis: long-term daily clinical practice data in a prospective cohort. Br J Dermatol. 2014;171(2):363–9.
Gooderham M, Debarre JM, Grant JK, et al. Safety and efficacy of calcipotriol plus betamethasone dipropionate gel in the treatment of scalp psoriasis in adolescents 12–17 years of age. Br J Dermatol. 2014;171(6):1470–7.
Kragballe K, Austad J, Barnes L, et al. A 52-week randomized safety study of a calcipotriol/betamethasone dipropionate two-compound product (Dovobet/Daivobet/Taclonex) in the treatment of psoriasis vulgaris. Br J Dermatol. 2006;154:1155-60.
Van De Kerkhof PCM, De Hoop D, De Korte J, Kuipers MV. Scalp psoriasis, clinical presentations and therapeutic management. Dermatology. 1998;197:326-34.
Gemec G, et al. A new scalp formulation of calcipotriene plus betamethasone compared with its active ingredients and the vehicle in the treatment of scalp psoriasis: A randomized, double-blind, controlled trial. J Am Acad Dermatol. 2008;59:455-63.
Luger TA, Cambazard F, Larsen FG, et al. A Study of the Safety and Efficacy of Calcipotriol and Betamethasone Dipropionate Scalp Formulation in the Long-Term Management of Scalp Psoriasis. Dermatology. 2008;217:321-328. doi: 10.1159/000155642.
Lind M, Nielsen KT, Schefe LH, et al. Supersaturation of Calcipotriene and Betamethasone Dipropionate in a Novel Aerosol Foam Formulation for Topical Treatment of Psoriasis Provides Enhanced Bioavailability of the Active Ingredients. Dermatol Ther (Heidelb). 2016;6:413–425. https:// doi.org/10.1007/s13555-016-0125-6.
Leonardi C, Bagel J, Yamauchi P, et al. Efficacy and safety ofcalcipotriene plus betamethasone dipropionate aerosol foam in patients with psoriasis vulgaris – a randomized Phase III study (PSO-FAST). J Drugs Dermatol. 2015;14(12):1468–1477.
Lebwohl M, Tyring S, Bukhalo M, et al. Fixed combination aerosol foam calcipotriene 0.005 % (Cal) plus betamethasone dipropionate 0.064% (BD) is more efficacious than Cal or BD aerosol foam alone for psoriasis vulgaris-a randomized, doubleblind, multicenter, three-arm, phase 2 study. J Clin Aesthet Dermatol. 2016;9(2):34–41.
Koo J, Tyring S, Werschler WP, et al. Superior efficacy of calcipotriene and betamethasone dipropionate aerosol foam versus ointment in patients with psoriasis vulgaris—a randomized phase II study. J Dermatolog Treat. 2016;27:120–7.
Queille RC, Olesen M, Villumsen J, Lacour JP. Efficacy of an innovative aerosol foam formulation of fixed combination calcipotriol plus betamethasone dipropionate in patients with psoriasis vulgaris. Clin Drug Investig. 2015;35:239–45.
Paul C, Gold SL, et al. Calcipotriol plus betamethasone dipropionate aerosol foam provides superior efficacy vs. gel in patients with psoriasis vulgaris: randomized, controlled PSO-ABLE study. JEADV. 2017;31:119–126.
Kim ES, Frampton JE. Calcipotriol/ Betamethasone Dipropionate Foam: A Review in Plaque Psoriasis Drugs. 2016;76:1485–1492.
Karaska V, Tuppal R, Olesen M, et al. A novel aerosol foam formulation of calcipotriol and betamethasone has no impact on HPA axis and calcium homeostasis in patients with extensive psoriasis vulgaris. J Cutan Med Surg. 2015;20(1):44–51.
Seyger M, Abramovits W, Liljedahl M, Hoejen MN, Teng J. Safety and efficacy of fixed-dose combination calcipotriol (50 lg/g) and betamethasone dipropionate (0.5 mg/g) cutaneous foam in adolescent patients (aged 12 to <17) results of a phase II, open-label trial. J Eur Acad Dermatol Venereol. 2020;34:2026–2034.
Gold SL, et al. Calcipotriol Plus Betamethasone Dipropionate Aerosol Foam is Effective, Independent of Body Mass Index and the Extent and Severity of Psoriasis Dermatol Ther (Heidelb). 2016;6:667–673.
Remrod C, et al. Psychological differences between early and late onset psoriasis: a study of personality traits, anxiety and depression in psoriasis British Journal of Dermatology. 2013;169:p344–350.
