Acitretin 5mg/5ml oral solution

Background/objectivesThe mechanism of action of treatment drugs for psoriasis is based on anti-inflammation and the inhibition of epidermal proliferation, and retinoids and vitamin D3 derivatives are first-line therapy drugs for psoriasis. This meta-analysis aimed to comprehensively evaluate the efficacy and safety of calcipotriol-acitretin combination therapy for psoriasis and investigate its effect on serum inflammatory factors.MethodsA systematic search of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese biomedical literature service system (SinoMed), and Chinese Biomedical Journal Database (VIP), from the earliest record until Dec.13, 2024, was conducted. The outcomes were overall effective rate, Psoriasis Area and Severity Index (PASI) scores, inflammatory factor level and side effects.ResultsA total of 13 studies with 1196 patients were included in this meta-analysis. The results of this study show that the calcipotriol-acitretin combination therapy could improve the total effective rate when compared with acitretin [RR = 1.25, 95% CI (1.18, 1.33)] or calcipotriol [RR = 1.36, 95% CI (1.20, 1.56)] monotherapy. The combined therapy could decrease the PASI score observably when compared with acitretin monotherapy [SMD =  - 2.26, 95% CI (-3.24, -1.28)] or calcipotriol monotherapy [SMD =  - 3.79, 95% CI (-5.78, -1.79)]. Calcipotriol-acitretin combination therapy remarkably reduced the levels of TNF-α, IL-23, IL-17, INF-γ and IL-6 in serum, while increasing the levels of IL-4 and IL-10 within the serum, compared to acitretin monotherapy. This combination therapy did not increase the risk of skin irritation & burning pain, dry skin and perioral dermatitis. Notably, the incidence of perioral dermatitis was lower in combination therapy than acitretin monotherapy [P = 0.04, RR = 0.24, 95% CI (0.06, 0.93)].ConclusionsThe calcipotriol-acitretin combination therapy could be a safe and effective therapeutic strategy in the treatment of psoriasis. However, the lack of PROSPERO registration and the high heterogeneity in this study limited the conclusion, and more high-quality RCTs were needed for further evaluation.

Abstract licence: CC BY-NC-ND

Psoriasis is a chronic, immune-mediated inflammatory disorder that significantly impacts patients' quality of life. Oral systemic therapies, including methotrexate, cyclosporine, acitretin, and apremilast, remain integral to psoriasis management, particularly for patients with moderate-to-severe disease who cannot afford biologic therapy. While these treatments are effective, their long-term use is often limited by adverse effects, particularly hepatotoxicity. Methotrexate and acitretin are associated with liver toxicity, requiring regular monitoring, whereas cyclosporine presents a lower but notable risk. Apremilast, a phosphodiesterase 4 inhibitor, offers a safer hepatic profile but has lower efficacy than traditional systemic agents. Emerging therapies, such as TYK2 inhibitors, RORγt inhibitors, and novel PDE4 inhibitors, aim to improve treatment efficacy while minimizing adverse effects. Advances in understanding hepatotoxicity mechanisms have led to identifying predictive biomarkers and hepatoprotective strategies, including antioxidants and non-invasive imaging techniques. Personalized medicine approaches, including pharmacogenomics, are revolutionizing treatment selection by optimizing efficacy while minimizing toxicity risks. This comprehensive review examines oral psoriasis treatments' efficacy and hepatotoxicity profiles, discusses novel therapeutic developments, and explores strategies for mitigating liver-related adverse effects. A balanced approach that integrates clinical monitoring, lifestyle modifications, and emerging precision medicine techniques is essential for optimizing long-term treatment outcomes. Future research should focus on refining predictive models for drug-induced liver injury and developing targeted therapies with improved efficacy and safety profiles.

Abstract licence: CC BY