Calcitriol 3 μg/g Ointment: A New Topical Treatment for Psoriasis

Abstract

Vitamin D receptor modulators have been used extensively for years in the treatment of psoriasis. These agents have demonstrated comparable efficacy to mid-potency corticosteroids and have a good safety profile. Vitamin D receptor modulators are useful as single agents and when used in combination, rotational or sequential therapy with other psoriasis treatments. Calcitriol ointment (1α,25-dihydroxyvitamin D3), the naturally occurring, endogenous, biologically active metabolite of vitamin D3, has recently been approved in the United States as the only Vitamin D3 ointment (Vectical™) available for the topical treatment of psoriasis. Two randomized, double-blind, placebo-controlled clinical trials demonstrated the application of calcitriol 3 μg/g ointment twice daily for eight weeks produced significantly greater improvement than did vehicle ointment on physician-rated and patient-rated scores of global psoriasis severity and improvement in psoriasis symptoms from baseline. Long-term clinical trials have demonstrated that twice-daily calcitriol was safe and well-tolerated for one year or longer and that calcium homeostasis was not significantly affected by continuous treatment up to 52 weeks. A direct comparison of calcitriol and calcipotriol [calcipotriene (Dovonex®)] in patients with chronic plaque psoriasis found that the two agents produced generally similar improvements in psoriasis severity but that calcitriol was associated with fewer cutaneous adverse events. A second comparative study that examined calcitriol and calcipotriene for the treatment of psoriasis in sensitive areas found that calcitriol produced significantly less perilesional edema, erythema and stinging/burning than did calcipotriene. Several clinical trials also support calcitriol as part of combination therapy. Topical calcitriol ointment is a new, safe, effective and well-tolerated treatment that offers considerable flexibility in psoriasis care.