Efficacy

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One systematic review (search date 1999, 32 RCTs, 2530 people) has been published.69 Two additional RCTs were identified.

Versus placebo

Ten reports involving 395 people were available for analysis: five concerning etretinate and five acitretin. Inclusion criteria varied markedly (from >5% to >20% body surface area affected; "psoriasis of long duration" or not reported). Doses ranged considerably, from 10 mg/day to 75 mg/day; study duration varied from 8 to 52 weeks. Three of the trial protocols permitted the concomitant use of topical corticosteroid. Success criteria were generally an improvement of at least 75% in severity score, but the reporting of three trials did not allow differences in success rates to be calculated. Unsurprisingly, the results were heterogeneous. Nevertheless it appeared that doses of 75 mg/day (or 1 mg/kg/day) were required to show superiority over placebo.

Acitretin versus etretinate

Six patient series (n = 508) could be analysed. Etretinate and acitretin were of equal efficacy in inducing remission of psoriasis.

RePUVA versus PUVA alone

The results from six patient series using retinoid doses of at least 50 mg/day (n = 283) demonstrated a small increase in success rate of RePUVA over PUVA alone (rate difference 0-14, CI 0-04 to 0-23). Five trials for which results were available found a clear trend towards a reduction in the UVA dose required to achieve clearance when PUVA was given with retinoid therapy.

Retinoids + UVB versus UVB alone

Three RCTs (n = 149) showed a benefit of the combination over UVB alone.69-71

Versus ciclosporin

Two RCTs (n = 286) concluded that etretinate was less effective than ciclosporin at inducing remission of psoriasis within 10-12 weeks.64,65

Retinoids + topical corticosteroids versus retinoids alone

The results from two patient series (n = 160) showed that the combination of a moderately potent to potent topical corticosteroid with systemic retinoid therapy increased response rates.

Retinoids + topical calcipotriol versus retinoids alone

One study (n = 86) showed a clear benefit over the untreated side from 0-05% calcipotriol cream applied twice daily to one half of the body in patients receiving etretinate 50 mg daily for 9 weeks.69 In a second study (n = 135) the addition of twice-daily 0-05% calcipotriol cream to low-dose acitretin (20 mg daily) increased success rates (clearance or marked improvement) at 12 weeks from 41% to 67% (rate difference 0-26, CI 0-10 to 0-42)-73

Retinoids + fish oil versus retinoids alone

A small open RCT (n = 40) has claimed benefit from the addition of eicosapentaenoic acid to low-dose etretinate in the treatment of stable, chronic plaque psoriasis.74

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