References

1. Reitamo S. Tacrolimus: a new topical Immunomodulatory therapy for atopic dermatitis. J Allergy Clin Immunol 2001;107:445-8.

2. Nghiem P, Pearson G, Langley RG. Tacrolimus and pimecrolimus: from clever prokaryotes to inhibiting calcineurin and treating atopic dermatitis. J Am Acad Dermatol 2002;46:228-41.

3. Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess 2000;4(37).

4. Hanifin JM, Ling MR, Langley R, Breneman D, Rafal E. Tacrolimus ointment for the treatment of atopic dermatitis in adult patients: part I, efficacy. J Am Acad Dermatol 2001;44:S28-38.

5. Ruzicka T, Bieber T, Schopf E et al. A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group. N Engl J Med 1997;337:816-21.

6. Boguniewicz M, Fiedler VC, Raimer S, Lawrence ID, Leung DY, Hanifin J. A randomized, vehicle-controlled trial of tacrolimus ointment for treatment of atopic dermatitis in children. Pediatric Tacrolimus Study Group. J Allergy Clin Immunol 1998;102:637-44.

7. Paller A, Eichenfield LF, Leung DY, Stewart D, Appell M. A 12-week study of tacrolimus ointment for the treatment of atopic dermatitis in pediatric patients. J Am Acad Dermatol 2001;44:S47-57.

8. Reitamo S, Van Leent EJM, Ho V et al. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone acetate ointment in children with atopic dermatitis. J Allergy Clin Immumol 2002; 109:539-46.

9. Reitamo S, Rustin M, Ruzicka T et al. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone butyrate ointment in adult patients with atopic dermatitis. J Allergy Clin Immumol 2002; 109: 547-55.

10. FK506 Ointment Study Group. Phase III comparative study of FK506 ointment versus betamethasone valerate ointment in atopic dermatitis (trunk/extremities) (in Japanese). Nishinihon J Derm 1997;59:870-9.

11. FK506 Ointment Study Group. Phase III comparative study of FK506 ointment versus aclometasone dipropionate ointment in atopic dermatitis (face/neck) (in Japanese). Hihuka Kiyo (Dermatol Bull) 1997;92:277-82.

12. Kang S, Lucky AW, Pariser D, Lawrence I, Hanifin JM. Long-term safety and efficacy of tacrolimus ointment for the treatment of atopic dermatitis in children. J Am Acad Dermatol 2001;44:S58-64.

13. Soter NA, Fleischer AB Jr, Webster GF, Monroe E, Lawrence I. Tacrolimus ointment for the treatment of atopic dermatitis in adult patients: part II, safety. J Am Acad Dermatol 2001;44:S39-46.

14. Reitamo S, Wollenberg A, Schopf E et al. Safety and efficacy of 1 year of tacrolimus ointment monotherapy in adults with atopic dermatitis. The European Tacrolimus Ointment Study Group. Arch Dermatol 2000; 136: 999-1006.

15. Boucher M. Tacrolimus ointment for the treatment of atopic dermatitis. Issues Emerg Health Technol 2001;19:1-4.

16. Furue M, Terao H, Rikihisa W et al. Clinical dose and adverse effects of topical steroids in daily management of atopic dermatitis. Br J Dermatol 2002 (in press).

17. Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol 2000;142:931-6.

18. Sugiura H, Uehara M, Hoshino N, Yamaji A. Long-term efficacy of tacrolimus ointment for recalcitrant facial erythema resistant to topical corticosteroids in adult patients with atopic dermatitis. Arch Dermatol 2000;136: 1062-3.

19. Kawakami T, Soma Y, Morita E et al. Safe and effective treatment of refractory facial lesions in atopic dermatitis using topical tacrolimus following corticosteroid discontinuation. Dermatology 2001;203:32-7.

20. Mayer K, Reinhard T, Reis A, Bohringer D, Sundmacher R. [FK 506 ointment 0-1 % - A new therapeutic option for atopic blepharitis. Clinical trial with 14 patients]. Klin Monatsbl Augenheilkd 2001;218:733-6.

Like tacrolimus, pimecrolimus is a macrolide immunosupressive drug. It is currently available in the US and is due to be launched in the EU for the treatment for atopic eczema.1 The US approved indication for pimecrolimus is for "short-term intermittent long-term therapy in the treatment of mild-to-moderate atopic dermatitis in non-immunocompromised patients 2 years of age and older, in whom the use of alternative, conventional therapies is deemed inadvisable because of potential risks, or in the treatment of patients who are not adequately responsive to or are intolerant to conventional therapies".2 The indications for use in the EU and elsewhere are likely to be similar, although a case is being made to use pimecrolimus for intermittent long-term treatment to prevent progression of flares in patients aged 3 months and older. The primary indication of use is almost identical to that described for topical tacrolimus, the only difference being that pimecrolimus is aimed at mild-to-moderate atopic dermatitis and tacrolimus for moderate-to-severe atopic dermatitis. Given that mild atopic eczema is about ten times more frequent than moderate-to-severe disease,3 the market could be a lot larger for pimecrolimus.

The mode of action of pimecrolimus is thought to be similar to tacrolimus and ciclosporin in preventing the release of calcineurin-mediated cytokine and pro-inflammatory mediators from mast cells and T cells.4 Preliminary animal studies published in abstract form have suggested that pimecrolimus has little effect on systemic immune responses.5

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