Dhar Sandipan, De Abhishek, Saha Abhijit, Chitnis Kruttika R, Mane Abhishek, Dhoot Dhiraj, Barkate Hanmant
Dermatology, Institute of Child Health, Kolkata, IND.
Dermatology, Calcutta National Medical College and Hospital, Kolkata, IND.
Cureus. 2023 Dec 16;15(12):e50640. doi: 10.7759/cureus.50640. eCollection 2023 Dec.
Topical calcineurin inhibitors (TCIs) and topical corticosteroids (TCS) are the mainstays of flare management for atopic eczema or atopic dermatitis (AD). Tacrolimus (an immunomodulator), belongs to the class of calcineurin inhibitors, with promising efficacy in AD. We performed this systematic review to obtain an up-to-date coverage map of controlled clinical trials of sequential or intermittent treatments with TCI as a therapeutic intervention for AD. Articles of interest were retrieved from PubMed, Google Scholar, and EMBASE published between between January 2000 and March 2023. Key words were "calcineurin inhibitors," "corticosteroids," "atopic dermatitis," "pruritus," "sequential," "intermittent" and "consecutive" while fixed language search consisted of "Intermittent topical calcineurin inhibitors AND topical corticosteroids AND atopic dermatitis OR eczema" AD patients who were administered sequential and/or intermittent applications of TCI for management of atopic eczema were included. Outcome measures included but were not limited to Scoring of Atopic Dermatitis (SCORAD) and the Eczema Area Severity Score (EASI). Four clinical trials were considered for the purpose of review. A total of 101 patients with AD were analysed. The risk of bias was low in two studies, while the other two had an unclear risk of bias. Overall, pooled data from two trials revealed that sequential therapy with TCS/TCI was comparable to monotherapy or emollients, as the test for overall effect determined was non-significant with a p-value of 0.33. The two studies were highly heterogeneous, as indicated by a very high I of 92% and an extremely significant p-value (p=0.0005). Sequential therapy with TCS and TCIs was effective and well tolerated in the management of AD and it may be considered an important treatment approach during the initial period.
外用钙调神经磷酸酶抑制剂（TCIs）和外用糖皮质激素（TCS）是特应性湿疹或特应性皮炎（AD）发作期治疗的主要手段。他克莫司（一种免疫调节剂）属于钙调神经磷酸酶抑制剂类别，在AD治疗中疗效显著。我们进行了这项系统评价，以获取关于将TCI作为AD治疗干预手段进行序贯或间歇治疗的对照临床试验的最新覆盖图。从2000年1月至2023年3月期间发表在PubMed、谷歌学术和EMBASE上检索感兴趣的文章。关键词为“钙调神经磷酸酶抑制剂”、“糖皮质激素”、“特应性皮炎”、“瘙痒”、“序贯”、“间歇”和“连续”，而固定语言搜索包括“间歇外用钙调神经磷酸酶抑制剂和外用糖皮质激素和特应性皮炎或湿疹”。纳入了接受TCI序贯和/或间歇应用治疗特应性湿疹的AD患者。结局指标包括但不限于特应性皮炎评分（SCORAD）和湿疹面积严重程度评分（EASI）。为进行综述考虑了四项临床试验。共分析了101例AD患者。两项研究的偏倚风险较低，而另外两项研究的偏倚风险不明确。总体而言，两项试验的汇总数据显示，TCS/TCI序贯疗法与单一疗法或润肤剂相当，因为确定的总体效应检验无统计学意义，p值为0.33。两项研究具有高度异质性，异质性指数I非常高，为92%，p值极显著（p = 0.0005）。TCS和TCIs序贯疗法在AD管理中有效且耐受性良好，在初始阶段可被视为一种重要的治疗方法。
