Objective To assess the efficacy and safety of adalimumab on plaque psoriasis. Methods We searched the MEDLINE (1966 to December 2009), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 12, 2009), EMbase (1980 to December 2009), CBM (1978 to December 2009), and CNKI (1979 to December 2009) to collect randomized controlled trials (RCTs) of adalimumab for plaque psoriasis. The language was confined to English and Chinese. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses by using the Cochrane Collaboration’s RevMan 4.2 software. Results Three RCTs involving 1?630 patients with chronic moderate or severe plaque psoriasis were included and assessed. At the end of 4th, 8th, 12th and 16th week, the PASI 75s of subcutaneous injection every other week in adalimumab (EOW) group were obviously higher than that of placebo group and methotrexate group. While at the end of 24th week and 60th week, the PASI 75s showed no difference between adalimumab EOW and placebo group. Twelve weeks after subcutaneous injection each week with adalimumab (QW), PASI 75 was obviously higher than those of placebo and EOW groups. However, at the end of 24th week and 60th week, there was no significant difference between adalimumab QW and placebo followed by adalimumab EOW. At end of week 12-16, there was no difference between adalimumab EOW group and placebo group in the incidence of adverse effects, with the exception of pain on injection site and upper respiration viral infection. At week 12-60, there was no difference between adalimumab QW and EOW groups in the incidence of adverse effects, with the exception of all serious adverse effects. Conclusion The limited evidence indicates that subcutaneous injection of adalimumab every other week for 12-16 weeks is safe and efficient for patients with moderate or severe plaque psoriasis. The efficacy can’t be enhanced when the treatment is prolonged to 24 weeks. The once-a-week protocol has no obvious advantage over every other week protocol. More RCTs are required to verify these conclusions owing to the limitations of the present study.
Objective To assess the efficacy and safety of tacrolimus and pimecrolimus ointment for treating Vitiligo. Methods We searched the MEDLINE (1966 to June 2008), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2008), OVID (1978 to June 2008), EMbase (1980 to June 2008), CBM (1978 to June 2008), and CNKI (1979 to June 2008) to collect randomized controlled trials (RCTs). We also handsearched relevant journals and conference proceedings. The language was confined to English and Chinese. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses using the Cochrane Collaboration’s RevMan 4.2 software. Results Fourteen trials involving 414 patients in 11 self-control trials and 182 patients in other 3 trials were included and assessed. The rate of 75% repigmentation induced by combination of topical tacrolimus with monochromatic excimer light was higher than that of control [RR= – 2.28, 95%CI (1.02, 5.10)]. The efficacy rate of combination treatment was also obviously higher than that of control [RR= 1.24, 95%CI (1.13, 1.37)]. The irradiation number of initial repigmentation induced by combination of topical pimecrolimus with monochromatic excimer light was less than that of control [WMD= – 3.00, 95%CI (– 3.22, – 2.78)], and the repigmentationrate of facial lesions in the combination group was higher than that of control. The efficacy rate of topical tacrolimus combination with Fufang Kaliziran Ding was significantly higher than that of control [RR= 1.83, 95% (1.14, 2.94)]. No significant difference was seen between topical tacrolimus combination with the NB-UVB group and the control group, or between the topical tacrolimus or pimecrolimus alone group with the control group. The side effects were limited and brief. Conclusion The limited evidence indicats that the combination of topical tacrolimus with monochromatic excimer light or Fufang Kaliziran Ding could improve the efficacy rate of treating vitiligo leukoplakia. The combination of topical pimecrolimuswith monochromatic excimer light shortens the irradiation number of initial repigmentation and works better on facial lesions.
Objective To assess the efficacy and safety of tacalcitol and calcitriol on vitiligo. Methods?We searched the MEDLINE (1966 to June 2008), Cochrane Central Register of Controlled Trials (The Cochrane Library, issue 4, 2008), OVID (1978 to June 2008), EMbase (1980 to June 2008), CBM (1978 to June 2008), CNKI (1979 to June 2008) to collect randomized controlled trials (RCTs). We also hand searched relevant journals and conference proceedings. The language was confined to English and Chinese. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses by using the Cochrane Collaboration’s RevMan 4.2 software. Results?Ffiteen trials involving 120 patients in 5 self-control trials and 793 patients in other 10 randomized controlled trials were included and assessed. The time of repigmentation onset of good responders and normal responders in the side treated with a combination of topical talcitol and NB-UVB was shorter than that in the control group [WMD= –?75, 95%CI (–?93.93, –?56.07); WMD= –?48, 95%CI (–?76.36, –?19.64)]. The mean number and cumulative dose of excimer light exposures for initial repigmentation in the side treated with tacalcitol and 308-nm monochromatic excimer light were less than those in the control group [WMD= –?0.78, 95%CI (–?1.02, –?0.54; WMD= –?1.06, 95%CI (–?1.36, –?0.76)]. The mean number of UVA exposures for initial repigmentation and complete repigmentation in the side treated with calcipotriol and PUVA were less than those in the control group [WMD= –?2.67, 95%CI (–?3.06, –?2.28); WMD= –?2.67, 95%CI (–?3.42, –?1.92)], and the cumulative UVA dose for iniitial and complete repigmentation in the combination group were also lower than those in the control group [WMD= –?25.68, 95%CI (–?29.44, –?21.92); WMD= –?27.14, 95%CI (–?34.80, –?19.48)]. The mean time of initial pigmentation was much shorter in the group treated with calcipotriol and corticosteroid was shorter than that in the control group [WMD= –?3.87, 95%CI (–?5.45, –?2.29)]. Conclusion?The limited evidence indicated that combination of topical tacalcitol with NB-UVB or monochromatic excimer light, or the combination of topical calcipotriol with PUVA or corticosteroid shortened the time of repigmentation and decreased the cumulative irradiation dose. The side effects were limited. No obvious effect was seen on re-pigmentation degree.