A systematic review 1 including 11 RCTs with a total of 756 subjects was abstracted in DARE. When using the outcome of PASI, the antipsoriatic effects of acitretin, cyclosporine, and psoralen-UV-A phototherapy were enhanced by the addition of topical calcipotriene. This did not, however, translate into an increase in the number of patients who achieved at least marked improvement. At the end of treatment, the RRs for marked improvement or clearance in patient assessments were:
for calcipotriene plus acitretin versus acitretin alone (12 weeks), 1.4 (95% CI: 1.0 to 1.9);
for calcipotriene plus cyclosporine versus cyclosporine alone (6 weeks), 1.2 (95% CI: 0.9 to 1.6); and
for calcipotriene plus psoralen-UV-A versus psoralen-UV-A alone (12 weeks), 1.2 (95% CI: 0.9 to 1.6).
Patients were also no more likely to obtain at least marked improvement with calcipotriene plus UV-B therapy than with UV-B therapy alone (RR 1.0, 95% CI: 0.8 to 1.1) at 8 weeks in the patient assessment. There was limited evidence that the use of calcipotriene might reduce the cumulative exposure to phototherapy and systemic treatment. During the short duration of these trials, there were no significant differences in withdrawal rates or adverse effects between the combined regimens and their corresponding monotherapy control interventions.
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