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Low-Dose Acitretin Is Associated With Fewer Adverse Events Than High-Dose Acitretin in the Treatment of Psoriasis
Daniel J. Pearce, MD;
Stephen Klinger, BS;
Kristin K. Ziel, MS;
Emma J. Murad, BS;
Richard Rowell, MPH;
Steven R. Feldman, MD, PhD
Arch Dermatol. 2006;142:1000-1004.
Objective In practice, lower dose acitretin therapy (25 mg/d) seems to be better tolerated and associated with fewer abnormalities found after laboratory testing. Here we revisit the original phase 3 trials for acitretin to evaluate the evidence for low-dose therapy producing fewer adverse effects than the 50 mg/d dosage.
Design We retrospectively analyzed pooled data from 2 large pivotal trials, each including a randomized, placebo-controlled, 8-week double-blind phase followed by a 16-week open-label phase.
Setting Multicenter pivotal trial of subjects in referral centers and private practice.
Participants Subjects with severe psoriasis requiring systemic therapy were recruited according to inclusion/exclusion criteria.
Intervention During the double-blind phase, subjects received placebo or one of several fixed acitretin doses. Dose adjustment was allowed during the open-label phase, during which high-dose treatment was defined as a mean dosage of 50 mg/d and low-dose treatment was defined as a mean dosage of 25 mg/d.
Main Outcome Measures The frequency of anomalies found after laboratory testing and clinical adverse events were the outcomes of interest.
Results Common adverse effects (dry skin, alopecia, rhinitis, etc) were 2 to 3 times more frequent in subjects receiving 50-mg/d acitretin than in those receiving 25 mg/d. Increases in hepatic enzymes and triglycerides in subjects receiving low-dose therapy were minimal compared with levels in those receiving high-dose therapy.
Conclusions We have shown low-dose therapy (25 mg/d) to be an effective strategy for substantially reducing acitretin-associated adverse effects. Many adverse effects associated with acitretin therapy are dose dependent and can limit the usefulness of this potentially beneficial therapy.
Author Affiliations: Departments of Dermatology (Drs Pearce and Feldman, Mr Klinger, and Mss Ziel and Murad), Pathology (Dr Feldman), and Public Health Sciences (Dr Feldman), Wake Forest University School of Medicine, Winston-Salem, NC; and Connetics Corporation (Mr Rowell), Palo Alto, Calif.
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