This review of clinical trials aimed to find out whether topical pimecrolimus is better than topical corticosteroids or tacrolimus for treating eczema in infants, children and adults by assessing the improvement of eczema and adverse events associated with treatments.
Eczema (atopic dermatitis) is a very common and long-lasting skin disease caused by both genetic and environmental factors, and most often begins in infancy and childhood. Corticosteroid creams have been used to treat eczema but may cause unwanted side effects, including thinning of the skin. Pimecrolimus cream was developed as an alternative to topical corticosteroids, but it is much more expensive than corticosteroids. It is also not clear whether pimecrolimus is more effective or better tolerated than corticosteroids or a similar drug called tacrolimus.
This review included data from 31 clinical trials involving 8019 participants. In the short-term (less than six weeks) treatment of eczema, we found pimecrolimus was more effective and well-tolerated when compared against vehicle (cream base not containing any pimecrolimus). Likewise, pimecrolimus was better than vehicle cream in preventing deterioration in eczema based on data from 9 trials involving 3091 participants. However, we found that 3 weeks treatment with pimecrolimus was less effective than a moderate (triamcinolone acetonide, data from 1 trial with 658 participants) and a potent topical corticosteroid (betamethasone valerate, data from 1 trial with 87 participants). Furthermore, 6-weeks treatment with pimecrolimus was less effective and caused more participants to drop out of treatment due to lack of efficacy than tacrolimus based on 2 trials involving 639 participants.
Pimecrolimus caused a similar rate of adverse events to vehicle cream but had a lower overall dropout rate. In contrast, pimecrolimus had higher dropout rates and caused more skin burning than topical corticosteroids. None of the trials reported on key adverse effects, such as thinning of skin. Pimecrolimus caused a similar rate of adverse events to tacrolimus. There were no cancer-related events reported in any of the 31 clinical trials.
This review did not find evidence to support the notion that pimecrolimus was better than moderate or potent corticosteroids or tacrolimus in treating eczema. However, there is a distinct lack of trials comparing pimecrolimus against mild-potency corticosteroids.