Effects of pimecrolimus cream 1% in the treatment of patients with atopic dermatitis who demonstrate a clinical insensitivity to topical corticosteroids

A randomized, multicentre vehicle-controlled trial

D. Y M Leung, Jon Hanifin, D. M. Pariser, K. A. Barber, R. G. Langley, P. M. Schlievert, B. Abrams, T. Hultsch

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background Colonization with Staphylococcus aureus in atopic dermatitis (AD) is often associated with worsening of clinical symptoms. Staphylococcus aureus produces superantigens that contribute to cutaneous inflammation and corticosteroid (CS) resistance. Objectives To investigate the relationship between CS insensitivity, S. aureus colonization and superantigen production in AD, and to explore the efficacy of pimecrolimus cream in CS-insensitive AD. Methods This was a randomized, double-blind, vehicle-controlled, multicentre, parallel-group study. Seventy-three patients with AD, aged 2-49 years, who had a documented clinical insensitivity to topical CS, were recruited. The primary efficacy parameters combined laboratory (including S. aureus colonization, superantigens) and clinical assessments [including Eczema Area and Severity Index (EASI), whole body Investigator's Global Assessment (IGA), pruritus assessment score, patient's assessment score of disease control]. Results An increase in S. aureus counts correlated with worsening of clinical score (week 6 vs. baseline) when assessed by IGA, pruritus severity and patient assessment. The presence of superantigens correlated with this worsening. During the 6-week double-blind phase, disease improvement in the pimecrolimus cream group was demonstrated by decreasing EASI scores compared with vehicle. Mean EASI scores for the head and neck showed greater improvement in the pimecrolimus cream group than in the vehicle group at all observed time points. Conclusions In a cohort of patients with clinical insensitivity to CS there was a significant positive correlation between S. aureus and disease severity. Results suggest that for some of these patients, treatment with pimecrolimus cream 1% is useful, especially in the head ?neck area.

Original languageEnglish (US)
Pages (from-to)435-443
Number of pages9
JournalBritish Journal of Dermatology
Volume161
Issue number2
DOIs
StatePublished - 2009

Fingerprint

Atopic Dermatitis
Staphylococcus aureus
Superantigens
Adrenal Cortex Hormones
Eczema
Pruritus
Neck
Therapeutics
Head
Research Personnel
pimecrolimus
Inflammation
Skin

Keywords

  • Atopic dermatitis
  • Corticosteroid
  • Insensitivity
  • Pimecrolimus
  • Staphylococcus aureus
  • Superantigens

ASJC Scopus subject areas

  • Dermatology
  • Medicine(all)

Cite this

Effects of pimecrolimus cream 1% in the treatment of patients with atopic dermatitis who demonstrate a clinical insensitivity to topical corticosteroids : A randomized, multicentre vehicle-controlled trial. / Leung, D. Y M; Hanifin, Jon; Pariser, D. M.; Barber, K. A.; Langley, R. G.; Schlievert, P. M.; Abrams, B.; Hultsch, T.

In: British Journal of Dermatology, Vol. 161, No. 2, 2009, p. 435-443.

Research output: Contribution to journalArticle

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abstract = "Background Colonization with Staphylococcus aureus in atopic dermatitis (AD) is often associated with worsening of clinical symptoms. Staphylococcus aureus produces superantigens that contribute to cutaneous inflammation and corticosteroid (CS) resistance. Objectives To investigate the relationship between CS insensitivity, S. aureus colonization and superantigen production in AD, and to explore the efficacy of pimecrolimus cream in CS-insensitive AD. Methods This was a randomized, double-blind, vehicle-controlled, multicentre, parallel-group study. Seventy-three patients with AD, aged 2-49 years, who had a documented clinical insensitivity to topical CS, were recruited. The primary efficacy parameters combined laboratory (including S. aureus colonization, superantigens) and clinical assessments [including Eczema Area and Severity Index (EASI), whole body Investigator's Global Assessment (IGA), pruritus assessment score, patient's assessment score of disease control]. Results An increase in S. aureus counts correlated with worsening of clinical score (week 6 vs. baseline) when assessed by IGA, pruritus severity and patient assessment. The presence of superantigens correlated with this worsening. During the 6-week double-blind phase, disease improvement in the pimecrolimus cream group was demonstrated by decreasing EASI scores compared with vehicle. Mean EASI scores for the head and neck showed greater improvement in the pimecrolimus cream group than in the vehicle group at all observed time points. Conclusions In a cohort of patients with clinical insensitivity to CS there was a significant positive correlation between S. aureus and disease severity. Results suggest that for some of these patients, treatment with pimecrolimus cream 1{\%} is useful, especially in the head ?neck area.",
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AU - Abrams, B.

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