Long-term topical management of plaque psoriasis
A review of the data on proactive maintenance with Cal/BD foam
Abstract
Psoriasis is a common, chronic inflammatory condition that has a significant impact on quality of life (QoL). The goals of treatment focus on reduction of disease activity and improvement in QoL. The UPLIFT survey of patients revealed that reduction of itch was the most important treatment goal followed by symptom control and skin clearance. Symptom improvement was the most important attribute of ideal therapy.
Short-term itch reduction and symptom improvement are attainable treatment goals with topical therapies, particularly for patients with mild-to-moderate disease. Long-term psoriasis management can be challenging due to the recurrent and relapsing nature of the disease, loss of clinical response over time and poor treatment adherence. In addition, steroid phobia and strict adherence to the topical steroid labelling which limits their use to 4 consecutive weeks have been barriers to long-term topical steroid use. Published literature involving expert recommendations for the long-term topical management using a proactive treatment strategy to improve disease control and optimize patient adherence has recently emerged.
References
Krueger G, Koo J, Lebwohl M, Menter A, Stern RS, Rolstad T. The Impact of Psoriasis on Quality of Life: Results of a 1998 National Psoriasis Foundation Patient-Membership Survey. Arch Dermatol. 2001;137(3):280–284. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-137-3-dst0024
Armstrong AW, Schupp C, Wu J, Bebo B. Quality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003–2011. PloS one. 2012 Dec 28;7(12):e52935.
Gulliver W, Lynde C, Dutz JP, et al. Think beyond the skin: 2014 Canadian Expert Opinion Paper on Treating to Target in Plaque Psoriasis. J Cutan Med Surg. 2015;19:22-7. doi:10.2310/7750.2014.13151
Mahil SK, Wilson N, Dand N, et al. Psoriasis treat to target: defining outcomes in psoriasis using data from a real-world, population-based cohort study (the British Association of Dermatologists Biologics and Immunomodulators Register, BADBIR). Br J Dermatol. 2020;182:1158-66. doi: 10.1111/bjd.18333
Gisondi P, Talamonti M, Chiricozzi A, et al. Treat-to-Target Approach for the Management of Patients with Moderate-to-Severe Plaque Psoriasis: Consensus Recommendations. Dermatol Ther (Heidelb). 2021 Feb;11(1):235-252. doi: 10.1007/s13555-020-00475-8.
Armstrong AW, Siegel MP, Bagel J, et al. From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis. J Am Acad Dermatol. 2017;76:290-8. doi: 10.1016/j.jaad.2016.10.017.
Lebwohl M, Langley RG, Paul C, et al. Evolution of Patient Perceptions of Psoriatic Disease: Results from the Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) Survey. Dermatol Ther (Heidelb). 2022 Jan;12(1):61-78. doi: 10.1007/s13555-021-00635-4. Epub 2021 Oct 25. Erratum in: Dermatol Ther (Heidelb). 2022 Jan 6;: PMID: 34704231; PMCID: PMC8547901.
Pink AE, Jalili A, Berg P, Calzavara-Pinton PG, et al. Rapid onset of action of calcipotriol/betamethasone dipropionate cutaneous foam in psoriasis, even in patients with more severe disease. J Eur Acad Dermatol Venereol. 2019 Jun;33(6):1116-1123. doi: 10.1111/jdv.15398. Epub 2019 Mar 27. PMID: 30916417.
Lebwohl M, Thaçi D, Warren RB. Addressing challenges associated with long-term topical treatment and benefits of proactive management in patients with psoriasis. Journal of the European Academy of Dermatology and Venereology. 2021 Feb;35:35-41.
Mueller SM, Itin P, Vogt DR et al. Assessment of “corticophobia” as an indicator of non-adherence to topical corticosteroids: a pilot study. J Dermatolog Treat. 2017;28:104–111.
Fabbrocini G, Simone CD, Dapavo P, Malagoli P, Martella A, Calzavara-Pinton P. Long-term maintenance treatment of psoriasis: the role of calcipotriol/betamethasone dipropionate aerosol foam in clinical practice. Journal of Dermatological Treatment. 2022 Dec;61(12):1543–1551.
Papp KA, Dhadwal G, Gooderham M, et al. Emerging paradigm shift toward proactive topical treatment of psoriasis: A narrative review. Dermatol Ther. 2021 Nov;34(6):e15104. doi: 10.1111/dth.15104. Epub 2021 Sep 14. PMID: 34418251; PMCID: PMC9286633.
Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014 Jul;71(1):116-32. doi: 10.1016/j.jaad.2014.03.023. Epub 2014 May 9. PMID: 24813302; PMCID: PMC4326095.
Wollenberg A, Barbarot S, Bieber T, et al. European Dermatology Forum (EDF), the European Academy of Dermatology and Venereology (EADV), the European Academy of Allergy and Clinical Immunology (EAACI), the European Task Force on Atopic Dermatitis (ETFAD), European Federation of Allergy and Airways Diseases Patients’ Associations (EFA), the European Society for Dermatology and Psychiatry (ESDaP), the European Society of Pediatric Dermatology (ESPD), Global Allergy and Asthma European Network (GA2LEN) and the European Union of Medical Specialists (UEMS). Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol. 2018 May;32(5):657-682. doi: 10.1111/jdv.14891. Erratum in: J Eur Acad Dermatol Venereol. 2019 Jul;33(7):1436. PMID: 29676534.
Corbett MF. The response of psoriasis to betamethasone valerate and clobetasol propionate. A 6-month controlled study. Br J Dermatol. 1976; 94(Suppl 12):89–93.
Floden CH, Woodbridge P, Samman P, Kurwa AR. Comparison of the response of psoriasis over a 6-month period, to clobetasol propionate and fluocinolone acetonide ointments. Curr Med Res Opin. 1975;3(6):375–81.
Lambert J, Trompke C. Tacalcitol ointment for long-term control of chronic plaque psoriasis in dermatological practice. Dermatology. 2002;204(4):321-324. doi:10.1159/000063376.
Van De Kerkhof PC, Berth-Jones J, Griffiths CE, et al. Long-term efficacy and safety of tacalcitol ointment in patients with chronic plaque psoriasis. Br J Dermatol. 2002;146(3):414-422. doi:10.1046/j.1365-2133.2002.04567.x.
Van De Kerkhof P, Van Der Vleuten C, Gerritsen M, et al. Long-term efficacy and safety of once daily treatment of chronic plaque psoriasis with tacalcitol ointment. Eur J Dermatol. 1997;7:421-425.
Langner A, Ashton P, Van De Kerkhof PC, Verjans H. A long-term multicentre assessment of the safety and tolerability of calcitriol ointment in the treatment of chronic plaque psoriasis. Br J Dermatol. 1996;135(3):385-389.
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(4):321-328. doi:10.1159/000155642.
Svendsen MT, Andersen F, Andersen KH, et al. A smartphone application supporting patients with psoriasis improves adherence to topical treatment: a randomized controlled trial. Br J Dermatol. 2018;179(5):1062-1071.
Poulin Y, Papp K, Bissonnette R, et al. Clobetasol propionate shampoo 0.05% is efficacious and safe for long-term control of moderate scalp psoriasis. J Dermatol Treat. 2010;21(3):185-192.
Saraceno R, Camplone G, D’Agostino M, et al. Efficacy and maintenance strategies of two compound formulation calcipotriol and betamethasone dipropionate gel (Xamiol gel) in the treatment of scalp psoriasis: results from a study in 885 patients. J Dermatol Treat. 2014;25(1):30-33.
Zhu H, Wu Y, He CD, Chen HD. New treatment regimen with calcipotriol/betamethasone ointment on psoriasis vulgaris of stationary stage. Clin Ped Dermatol. 2016;2(1):3.
Lee JH, Park CJ, Kim TY, et al. Optimal maintenance treatment with calcipotriol/betamethasone dipropionate gel in Korean patients with psoriasis vulgaris: a multicentre randomized, controlled clinical trial. J Eur Acad Dermatol Venereol. 2017;31(3):483-489.
Lebwohl M, Yoles A, Lombardi K, Lou W. Calcipotriene ointment and halobetasol ointment in the long-term treatment of psoriasis: effects on the duration of improvement. J Am Acad Dermatol. 1998;39(3):447-450.
Koo J, Blum R, Lebwohl M. A randomized, multicenter study of calcipotriene ointment and clobetasol propionate foam in the sequential treatment of localized plaque-type psoriasis: short- and long-term outcomes. J Am Acad Dermatol. 2006;55(4):637-341.
Kragballe K, Austad J, Barnes L, et al. Efficacy results of a 52-week, randomised, double-blind, safety study of calcipotriol/betamethasone dipropionate two-compound product (Daivobet®/Dovobet®/ Taclonex®) in the treatment of psoriasis vulgaris. Dermatology. 2006;213(4):319-326.
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(6):1155-1160.
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, double-blind, multicenter, three-arm, phase 2 study. J Clin Aesthet Dermatol. 2016;9(2):34–41.
Leonardi C, Bagel J, Yamauchi P, et al. Efficacy and Safety of Calcipotriene Plus Betamethasone Dipropionate Aerosol Foam in Patients With Psoriasis Vulgaris–a Randomized Phase III Study (PSO-FAST). J Drugs Dermatol. 2015 Dec;14(12):1468-77. PMID: 26659941.
Paul C, Stein Gold L, Cambazard F, et al. Calcipotriol plus betamethasone dipropionate aerosol foam provides superior efficacy vs. gel in patients with psoriasis vulgaris: randomized, controlled PSO-ABLE study. J Eur Acad Dermatol Venereol. 2017;31(1):119–126. doi:10.1111/jdv.13859.
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(2):120–127. doi:10.3109/09546634.2015.1083935.
Pink AE, Jalili A, Berg P, et al. Rapid onset of action of calcipotriol/betamethasone dipropionate cutaneous foam in psoriasis, even in patients with more severe disease. J Eur Acad Dermatol Venereol. 2019;33(6):1116–1123. doi:10.1111/jdv.15398.
Jalili A, Lebwohl M, Stein Gold L, et al. Itch relief in patients with psoriasis: effectiveness of calcipotriol plus betamethasone dipropionate foam. J Eur Acad Dermatol Venereol. 2019;33(4):709–717. doi:10.1111/jdv.15393.
Griffiths CE, Stein Gold L, Cambazard F, et al. Greater improvement in quality of life outcomes in patients using fixed-combination calcipotriol plus betamethasone dipropionate aerosol foam versus gel: results from the PSO-ABLE study. Eur J Dermatol. 2018 Jun 1;28(3):356-363. doi: 10.1684/ejd.2018.3302. PMID: 29952297.
Lebwohl M, Kircik L, Lacour JP, et al. Twice-weekly topical calcipotriene/betamethasone dipropionate foam as proactive management of plaque psoriasis increases time in remission and is well tolerated over 52 weeks (PSO-LONG trial). J Am Acad Dermatol. 2021 May;84(5):1269-1277. doi: 10.1016/j.jaad.2020.09.037. Epub 2020 Sep 18. PMID: 32950546.
Lebwohl MG, Papp KA, Mørch MH, Bernasconi MYJ, Warren RB. Long-Term Proactive Treatment of Plaque Psoriasis with Calcipotriene/Betamethasone Dipropionate Foam Prolongs Remission and Reduces Relapses Irrespective of Patient Baseline Characteristics. Dermatol Ther (Heidelb). 2021;11(5):1657-1665. doi:10.1007/s13555-021-00585-x.
Kircik L, Holst March M, Peterson B, Lilijedahl M, Wollen Best A. 2021. Long-term treatment of plaque psoriasis with Cal/BD foam was locally well tolerated and not associated with skin atrophy. AAD VMX. 2021 April 23-25.
Papp K, Adamski Z, Guenther L, et al. Efficacy and safety of proactive treatment with twice-weekly topical Cal/BD foam in patients with plaque psoriasis undergoing HPA-axis testing: a PSO-LONG subgroup analysis. J Dermatolog Treat. 2022;33(4):2297-2304. doi:10.1080/09546634.2021.1959501.
Jalili A, Calzavara Pinton P, Kircik L, et al. Quality of life and patient-perceived symptoms in patients with psoriasis undergoing proactive or reactive management with the fixed-dose combination Cal/BD foam: A post-hoc analysis of PSO-LONG. J Eur Acad Dermatol Venereol. 2022;36(1):60-67. doi:10.1111/jdv.17673.
Guenther L, Takhar A, Megna M, Sebastian M, Nyholm N, Thoning H, Levin LÅ. Impact of fixed-dose combination Cal/BD foam on the work productivity of patients with psoriasis: results from the 52-week randomized, double-blind, PSO-LONG trial. J Eur Acad Dermatol Venereol. 2022 Jul;36(7):1054-1063.
Harvima RJ, Gooderham M, Tyring S, Thoning H, Nyholm N, Stein Gold L. Clinical, patient and estimated cost benefits of proactive management versus reactive management with calcipotriol/betamethasone dipropionate foam for the treatment of plaque psoriasis in Finland. J Dermatolog Treat. 2022 Jun;33(4):2234-2240. doi: 10.1080/09546634.2021.1942419. Epub 2021 Jul 7. PMID: 34130573.
