Calcipotriene-Betamethasone Dipropionate: Effective for Plaque Psoriasis?

A new study found that a vitamin D analog combined with a high-potency topical corticosteroid (calcipotriene-betamethasone dipropionate) may be effective for plaque psoriasis when used once a day in an aerosol foam formulation. Findings from this study were published in the Journal of Drugs and Dermatology.

Patients with plaque psoriasis affecting 3% to 20% body surface area and a baseline Physician Global Assessment (PGA) rating of moderate severity (PGA = 3) were enrolled in the open-label, 4-week pilot study (n=20). Researchers used the Target Lesion Severity Score (TLSS) cumulative rating system to identify target lesions on either the elbows or knees at baseline and every follow-up visit. The washout periods consisted of 2 weeks for topical antipsoriatic agents, 4 weeks for nonbiologic systemic therapies, 3 months for biologic therapies, and 2 weeks for phototherapy.

During the study period, patients applied either a vehicle foam or an aerosol foam formulation comprised of calcipotriene 0.005% and betamethasone dipropionate 0.064% per 1% body surface area on plaques. The researchers documented vital signs, PGA reductions, and adverse events at baseline, week 2, and week 4.

Although 100% of patients were rated moderate severity (PGA = 3) at baseline, at 2 weeks the percentage of patients rated moderate, mild (PGA = 2), and almost clear (PGA = 1) were 5%, 16%, and 30%, respectively (P <.0001). Greater efficacy was observed at 4 weeks with the active treatment (moderate [5%], mild [20%], almost clear [45%], and clear [30%]; P <.002).

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The reduction in target lesion size was significant from baseline to 4 weeks (19 cm2 to 10 cm2, respectively; P =.01). There were also significant reductions in erythema, induration, and scaling severities from baseline to week 2, as well as from week 2 to week 4 (P <.03). The 2 adverse events, gastroesophageal reflux and mild cough, were not considered related to the medication and completely resolved without further treatment.

Study limitations include the small sample size, the lack of a blinded randomized design, and the short follow-up period.

“This IIS provides documentation of the efficacy and tolerability of once daily application of [calcipotriene-betamethasone dipropionate] aerosol foam formulation used over a duration of 4 weeks for psoriatic plaques affecting the elbows and knees,” the researchers concluded.

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Del Rosso JQ, Kircik LH. The effect of calcipotriene-betamethasone dipropionate aerosol foam versus vehicle on target lesions in moderate severity plaque psoriasis: focus on elbows and knees. J Drugs Dermatol. 2019;18(4):358-361.