Efficacy and safety of calcipotriol plus betamethasone dipropionate scalp formulation compared with calcipotriol scalp solution in the treatment of scalp psoriasis: a randomized controlled trial

Kragballe K, Hoffmann V, Ortonne J P, Tan J, Nordin P, Segaert S

Br J Dermatol 2009 161(1) 159-166

Background: Current topical therapies for scalp psoriasis are difficult or unpleasant to apply, resulting in decreased adherence and efficacy.
Objectives: To compare the efficacy and safety of once-daily treatment with a combination of calcipotriol 50 μg g-1 plus betamethasone 0·5 mg g-1 (as dipropionate) (Xamiol®; LEO Pharma A ⁄S, Ballerup, Denmark) and twice-daily calcipotriol 50 μg mL-1 scalp solution in patients with scalp psoriasis.
Methods: This 8-week, multicentre, randomized, investigator-blind, parallel-group study compared two-compound calcipotriol ⁄betamethasone scalp formulation with calcipotriol scalp solution in patients with moderately severe scalp psoriasis. Primary efficacy outcome was the proportion of patients who achieved ‘clear’ or ‘minimal’ disease severity according to investigator’s global assessment of disease severity at week 8. Secondary efficacy outcomes and adverse events were also evaluated. Relapse and rebound were assessed in an 8-week, post-treatment observation phase.
Results: In total, 207 patients received the two-compound scalp formulation and 105 patients received calcipotriol scalp solution. The proportion of patients with ‘clear’ or ‘minimal’ disease at week 8 was significantly greater in the twocompound scalp formulation group (68·6%) than in the calcipotriol scalp solution group (31·4%; P < 0·001). Improvement was more rapid with the twocompound scalp formulation than with calcipotriol scalp solution. Further evidence of the superiority of the two-compound scalp formulation over the scalp solution was demonstrated through greater improvements in clinical signs and fewer adverse events.
Conclusions: A once-daily combination of calcipotriol plus betamethasone dipropionate was significantly more effective and better tolerated than twice-daily calcipotriol scalp solution in the treatment of scalp psoriasis.