Aspiring drummer, fifteen-year-old
Christopher Robinson's fervent hope is that the eczema
on his hands will clear up before the debut gig of his
band, Screaming Lizard. In Canada, for moderate eczema
like Chris's, doctors can prescribe either tacrolimus
ointment or pimecrolimus cream, both nonsteroidal topical
immunomodulators which are considered safer than corticosteroids.
Chris wants to know which one works best. Wouldn't it
be nice to have a simple answer for him? A study presented
at the 2004 American Academy of Dermatology provides evidence
that tacrolimus outperforms pimecrolimus on every measure
of efficacy and matches it for tolerability.
"This study is the first, large,
well-designed comparative trial to examine tacrolimus
ointment and pimecrolimus cream in the same patient
populations, including age, disease severity, length
of treatment, efficacy endpoints and adverse events,"
said lead researcher Dr Alan Fleischer, director of
the General Dermatology Clinic at the Wake Forest University
Baptist Medical Center in North Carolina. "In this study,
tacrolimus ointment seemed to work better for all severities
of atopic dermatitis than pimecrolimus, including mild
sufferers and particularly in severe patients."
Dr Fleischer's results also showed
that there's no significant difference between the two
medicines in terms of adverse effects such as burning
or stinging. The six-week, randomized, investigator-blinded
study evaluated 1,056 patients with mild to severe atopic
dermatitis (AD). Patients' symptoms were measured at
day one and at weeks one, three and six. As well as
the physician-rated Investigator's Global Atopic Dermatitis
Assessment and Body Surface Area assessment, an Eczema
Area and Severity Index score was calculated, and finally,
the patient's own all-important evaluation of itch was
recorded.
Tacrolimus beat out pimecrolimus
in treating both mild and severe pediatric AD. Forty-seven
percent of children with mild AD treated with tacrolimus
ointment 0.03% achieved "clear" or "almost clear" skin
compared with 41% of patients using pimecrolimus cream
1%. Similarly, 32% of patients aged 2 to 15 with severe
AD treated with tacrolimus ointment 0.1% saw significant
improvement, while only 18% of children treated with
pimecrolimus cream 1% did.
Tacrolimus also proved its superiority
in the adult arm of the study. Tacrolimus ointment 0.1%
was successful in clearing up skin 46% of the time compared
with a success rate of 27% for pimecrolimus cream 1%.
"This study supports existing data
that show that tacrolimus and pimecrolimus have the
same safety profile and comparable tolerability," said
Dr Fleischer. "Tacrolimus works more rapidly at the
skin's surface than pimecrolimus, yet existing data
indicate that neither medication showed a trend toward
higher blood accumulation over time, deeming them equally
safe. Patients treated with tacrolimus ointment for
all degrees of severity of atopic dermatitis experienced
a greater and more rapid reduction in itching symptoms,
which is key to improving the quality of life for these
patients."
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