Safety and efficacy of pimecrolimus versus vehicle for the treatment of atopic dermatitis in adults and paediatric population: a systematic review and meta-analysis

Sareema E Akhtar; Saad Shakil; Sabeeh K Farooqui; Tarek Khedro; Ahmad L Alzufairi; Muhammad A Niaz; Saifullah Syed; Riaz Jiffry; Abdulla K Alsubai; Abdullah Almesri; Hebatalla Ismail; Kashif A Khan; Ahmed Al-Hindawi; Hussein K Ali; Timothy Falodun; Aysa Tabassi; Aylin Tabassi; Talal Almas

doi:10.1097/MS9.0000000000000844

Safety and efficacy of pimecrolimus versus vehicle for the treatment of atopic dermatitis in adults and paediatric population: a systematic review and meta-analysis

Ann Med Surg (Lond). 2023 May 22;85(7):3563-3573. doi: 10.1097/MS9.0000000000000844. eCollection 2023 Jul.

Authors

Sareema E Akhtar¹, Saad Shakil¹, Sabeeh K Farooqui¹, Tarek Khedro², Ahmad L Alzufairi², Muhammad A Niaz², Saifullah Syed², Riaz Jiffry², Abdulla K Alsubai², Abdullah Almesri², Hebatalla Ismail², Kashif A Khan³, Ahmed Al-Hindawi⁴, Hussein K Ali², Timothy Falodun², Aysa Tabassi², Aylin Tabassi², Talal Almas²

Affiliations

¹ Ziauddin Medical College, Karachi, Pakistan.
² RCSI University of Medicine and Health Sciences, Dublin 2.
³ National University of Ireland, Galway, Ireland.
⁴ Royal College of Surgeons in Ireland-Bahrain, Bahrain.

Abstract

Atopic dermatitis remains a widespread problem affecting various populations globally. While numerous treatment options have been employed, pimecrolimus remains a potent and viable option. Recently, there has been increasing interest in comparing the safety and efficacy of pimecrolimus with its vehicle.

Methods: The authors conducted a comprehensive search of several databases, including PubMed, COCHRANE, MEDLINE, and Cochrane Central, from inception to May 2022, using a wide search strategy with Boolean operators. The authors also employed backward snowballing to identify any studies missed in the initial search. The authors included randomized controlled trials in our meta-analysis and extracted data from the identified studies. The authors used Review Manager (RevMan) Version 5.4 to analyze the data, selecting a random-effects model due to observed differences in study populations and settings. The authors considered a P-value of 0.05 or lower to be statistically significant.

Results: The authors initially identified 211 studies, of which 13 randomized controlled trials involving 4180 participants were selected for analysis. Our pooled analysis revealed that pimecrolimus 1% was more effective at reducing the severity of atopic dermatitis than its vehicles. However, no significant difference was observed in adverse effects between pimecrolimus and vehicle, except for pyrexia, nasopharyngitis, and headache, which were increased with pimecrolimus.

Conclusion: Our meta-analysis showed that pimecrolimus 1% is more effective than vehicle, although the safety profile remains inconclusive. Pimecrolimus reduced the Investigator's Global Assessment score, Eczema Area and Severity Index score, and severity of pruritus when compared to its vehicle, indicating a higher efficacy profile. This is one of the first meta-analyses to assess the efficacy and safety profile of pimecrolimus 1% against a vehicle and may assist physicians in making informed decisions.

Keywords: atopic dermatitis; eczema and dermatology; elidel; pimecrolimus.