Systematic review and meta-analysis of randomized clinical trials (RCTs) comparing topical calcineurin inhibitors with topical corticosteroids for atopic dermatitis: A 15-year experience

Background: Calcineurin inhibitors are alternatives to corticosteroid for treatment of atopic dermatitis.

Objectives: We sought to compare the beneficial effects and adverse events associated with these therapies in treating patients with atopic dermatitis.

Methods: Four databases were searched for randomized clinical trials comparing topical calcineurin inhibitors versus corticosteroids in children and adults. Methodological quality was evaluated to assess bias risk. Clinical outcome and costs were compared.

Results: Twelve independent randomized clinical trials comparing calcineurin inhibitors (n = 3492) versus corticosteroids (n = 3462) were identified. Calcineurin inhibitors and corticosteroids had similar rates of improvement of dermatitis (81% vs 71%; risk ratio [RR] 1.18; 95% confidence interval [CI] 1.04-1.34; P = .01) and treatment success (72% vs 68%; RR 1.15; 95% CI 1.00-1.31; P = .04). Calcineurin inhibitors were associated with higher costs and had more adverse events (74% vs 64%; RR 1.28; 95% CI 1.05-1.58; P = .02) including a higher rate of skin burning (30% vs 9%; RR 3.27; 95% CI 2.48-4.31; P < .00001) and pruritus (12% vs 8%; RR 1.49; 95% CI 1.24-1.79; P < .00001). There were no differences in atrophy, skin infections, or adverse events that were serious or required discontinuation of therapy.

Limitations: Only a small number of trials reported costs.

Conclusion: Calcineurin inhibitors and corticosteroids have similar efficacy. Calcineurin inhibitors are associated with higher costs and have more adverse events, such as skin burning and pruritus. These results provide level-1a support for the use of corticosteroids as the therapy of choice for atopic dermatitis.