Atopic dermatitis tacrolimus therapy

Pimecrolimus (SDZ ASM 981, Elidel) is another recently approved macrolide immunosuppressant that acts by inhibiting calcineurin and blocking the release of proinflammatory cytokines from T lymphocytes. The parent compound, ascomycin, was originally isolated from Streptomyces hygroscopicus var ascomyceticus. Like tacrolimus, pimecrolimus is approved for the topical treatment of moderate to severe atopic dermatitis that is refractory to other therapies. Transient local irritation is a common side effect. 

Because of the effectiveness of systemic tacrolimus in some dermatologic diseases, a topical preparation is now available. Tacrolimus ointment is currently used in the therapy of atopic dermatitis and psoriasis. 

The role of both T and B lymphocytes in a variety of disease states beyond transplantation has become increasingly important in the past decade. This is especially true of those diseases frequently referred to as autoimmune in their etiology, such as rheumatoid arthritis, nephrotic syndrome, systemic lupus erythematosus, inflammatory bowel disease, and so on. In addition, several other major diseases are also known to have a component of T- or B-cell-mediated pathogenesis, for example, atopic dermatitis, psoriasis, and asthma. Until very recently, the mainstay of therapy for these diseases was the corticosteroids, which were often less than satisfactory in efficacy and often associated with undesirable side effects, especially in growing children and the elderly. Thus, the search for new agents with different mechanisms of action and which did not have the same adverse event profile as conventional corticosteroids led to the subsequent evaluation of drugs such as tacrolimus and sirolimus to treat several of these diseases. 

Very recently topical tacrolimus (ointment) has been shown to be a very effective therapy for the treatment of moderate to severe atopic dermatitis, making it the first true alternative to steroids for treating this widespread disease. It seems... 

Drake et al. [122], using a validated quality-of-life (QOL) measurement instrument, assessed changes in QOL for all three U.S. phase 3 studies mentioned above. In that assessment, tacrolimus ointment therapy with either 0.1% or 0.03% was associated with a statistically significantly greater QOL improvement than placebo treatment in adults, children, and toddlers. As illustrated in Fig. 6, the patients preference for continuing on the study therapy supports the QOL benefits of tacrolimus ointment for atopic dermatitis from the patients perspectives. 

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterised by extreme pruritus and lichenified papules and plaques that may begin in or persist in to adulthood. Topical corticosteroids are first-line prescription therapy for AD they are efficacious and have a well established safety profile. The topical calcineurin inhibitors tacrolimus and pimecrolimus have been approved as second-line topical therapy for AD. The current review evaluates the available studies on the comparative effectiveness, safety, cost, and impact on quality of life of topical corticosteroids and topical calcineurin inhibitors for the treatment of adult AD [17 ]. 

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