Efficacy, quality of life, and treatment satisfaction: an indirect comparison of calcipotriol/betamethasone dipropionate cream versus foam for treatment of psoriasis

Figures & data

Table 1. Literature search string in PubMed (July 2021).

Drug		Outcomes		Disease
Calcipotriene OR calcipotriol AND “betamethasone dipropionate” OR Enstilar	AND	“Physician Global Assessment” OR PGA OR “Psoriasis Area and Severity Index” OR “Psoriasis Area Severity Index” OR PASI OR “Dermatology Life Quality Index” OR DLQI OR satisfaction OR preference	AND	Psoriasis

Exact search string: ((calcipotriene OR calcipotriol AND “betamethasone dipropionate” OR Enstilar) AND (“Physician Global Assessment” OR PGA OR “Psoriasis Area and Severity Index” OR “Psoriasis Area Severity Index” OR PASI OR “Dermatology Life Quality Index” OR DLQI OR satisfaction OR preference)) AND (psoriasis).

Figure 1. PRISMA flow diagram.

Table 2. PTCS questions matched with TPUQ questions covering five treatment satisfaction domains.

PTCS^14^,^18^,^19		TPUQ^23
Q1	How easy was the treatment to apply to the skin?	Q1	Ease of application
Q2	How greasy was the treatment when applying it to the skin?	Q16	Not greasy
Q3	How moisturized did your skin feel after applying the treatment?	Q15	Felt moisturizing
Q4	How greasy did your skin feel after applying the treatment?	Q16	Not greasy
Q5	How much did your skin disrupt your daily routine?	Q9	Easily incorporated into daily routine
Q6	Overall, how satisfied were you with the medical treatment?	Q26	Overall satisfaction

PTCS: Psoriasis Treatment Convenience Scale; Q#: question number; TPUQ: Topical Product Usability Questionnaire.

Table 3. Patient demographics and baseline characteristics.

	Cal/BDP cream pooled studies^a^30		PSO-ABLE study^20^,^22		PSO-INSIGHTFUL study^a^23
Treatment	Cal/BDP cream	Cal/BDP gel	Cal/BDP foam	Cal/BDP gel	All
n	551	542	185	188	212
Mean age, years (SD)	50.9 (14.1)	52.2 (14.2)	54.0 (14.5)	54.5 (14.9)	18–39 years: 48 (22.6%); 40–59 years: 92 (43.4%); ≥60 years: 72 (34.0%)
Female, n (%)	214 (38.8)	209 (38.6)	59 (31.9)	74 (39.2)	79 (37)
Mean BMI, kg/m^2 (SD)	30.1 (6.9)	30.1 (6.3)	29.7 (6.1)	30.3 (6.6)	<25 kg/m^2: 37 (17.5%); 25–30 kg/m^2: 73 (34.4%); >30 kg/m^2: 102 (48.1%)
PGA, n (%)
Mild	105 (19.1)	91 (16.8)	54 (29.2)	45 (23.9)	61 (28.8)
Moderate	446 (80.9)	451 (83.2)	109 (58.9)	124 (66.0)	122 (57.5)
Severe	0 (0.0)	0 (0.0)	22 (11.9)	19 (10.1)	29 (13.7)
Mean duration of psoriasis, years (SD)	17.9 (13.2)	16.6 (13.6)	19.3 (14.1)	19.0 (14.2)	<2 years: 4 (1.9%); 2–5 years: 30 (14.2%); >5 years: 178 (84.0%)
Mean BSA, % (SD)	8.0 (6.4)	8.7 (6.9)	7.1 (5.7)	7.0 (5.5)	<4%: 93 (43.9%); 4–6%: 56 (26.4%); 6–11%: 38 (17.9%); 11–15%: 11 (5.2%); ≥15%: 14 (6.6%)
Mean PASI (SD)	7.5 (3.9)	7.8 (4.0)	7.1 (4.5)	6.6 (3.6)	2–5: 86 (40.6%); 5.1–10: 91 (42.9%); >10: 35 (16.5%)

BMI: body mass index; BSA: body surface area; Cal/BDP: calcipotriene and betamethasone dipropionate; PASI: Psoriasis Area and Severity Index; PGA: Physician Global Assessment; SD: standard deviation.

^aMean age, BMI, duration of psoriasis, BSA and PASI not published.

Table 4. PGA treatment success and PASI75 response per week.

	Cal/BDP cream^30	Cal/BDP gel^30	Cal/BDP foam^20	Cal/BDP gel^20
Observations (N)	551	542	185	188
PGA treatment success (%)
Week 1	3.60	2.00	6.60	1.60
Week 4	25.20	15.60	38.30	19.60
Week 6	37.70	24.60	44.90	23.00
Week 8	43.20	31.90	44.50	22.50
Recommended treatment duration^a	43.20	31.90	38.30	22.50
PASI75 response (%)
Week 1	2.70	1.20	7.20	1.60
Week 4	22.10	13.70	52.10	24.30
Week 6	36.00	24.20	59.00	33.40
Week 8	44.30	34.50	59.30	34.60
Recommended treatment duration^a	44.30	34.50	52.10	34.60

Cal/BDP: calcipotriene and betamethasone dipropionate; PASI75: 75% reduction in Psoriasis Area and Severity Index; PGA: Physician Global Assessment.

^a8 weeks for Cal/BDP cream and gel and 4 weeks for Cal/BDP foam.

Table 5. Indirect comparison of PGA treatment success and PASI75 response between Cal/BDP cream and foam with the common comparator Cal/BDP gel.

	Cal/BDP cream vs. gel^30	Cal/BDP foam vs. gel^20	Cal/BDP cream vs. foam
			Relative difference			Absolute difference assuming event rate for Cal/BDP foam
PGA treatment success	RR	RR	RR^b	95%CI	p-Value	Difference	95%CI
Week 1	1.80	4.13	0.44	0.10; 1.85	.26	−3.72%	−5.92%; 5.60%
Week 4	1.62	1.95	0.83	0.54; 1.26	.37	−6.64%	−17.49%; 9.88%
Week 6	1.53	1.95	0.79	0.55; 1.12	.18	−9.65%	−20.22%; 5.45%
Week 8	1.35	1.98	0.68	0.48; 0.97	.03	−14.03%	−22.97%; −1.38%
Recommended treatment duration^a	1.35	1.70	0.80	0.56; 1.14	.21	−7.83%	−17.00%; 5.28%
PASI75 response
Week 1	2.25	4.50	0.50	0.11; 2.32	.38	−3.60%	−6.43%; 9.52%
Week 4	1.61	2.14	0.75	0.51; 1.11	.15	−12.90%	−25.56%; 5.79%
Week 6	1.49	1.77	0.84	0.62; 1.14	.26	−9.31%	−22.18%; 8.04%
Week 8	1.28	1.71	0.75	0.57; 0.99	.04	−14.87%	−25.52%; −0.86%
Recommended treatment duration^a	1.28	1.51	0.85	0.64; 1.13	.27	−7.67%	−18.61%; 6.85%

Cal/BDP: calcipotriene and betamethasone dipropionate; PASI75: 75% reduction in Psoriasis Area and Severity Index; PGA: Physician Global Assessment; RR: risk ratio; vs.: versus; 95%CI: 95% confidence interval.

^a8 weeks for Cal/BDP cream and gel and 4 weeks for Cal/BDP foam.

^bRR < 1 imply more events (PGA treatment success and PASI75 response) for Cal/BDP foam than Cal/BDP cream.

Table 6. Change in DLQI from baseline—DLQI improvement.

	Cal/BDP cream^30	Cal/BDP gel^30	Cal/BDP foam^22	Cal/BDP gel^22
DLQI improvement
Week 4	−5.7	−5.0	−4.3	−3.8
Week 8	−6.5	−5.6	−4.5	−4.4
Recommended treatment duration^a	−6.5	−5.6	−4.3	−4.4

Cal/BDP: calcipotriene and betamethasone dipropionate; DLQI: Dermatology Life Quality Index.

Data on DLQI improvement is measured as change in DLQI from baseline.

^a8 weeks for Cal/BDP cream and gel and 4 weeks for Cal/BDP foam.

Table 7. Indirect comparison of DLQI improvement between Cal/BDP cream and foam with the common comparator Cal/BDP gel.

	Cal/BDP cream vs. gel^30	Cal/BDP foam vs. gel^22	Cal/BDP cream vs. foam
DLQI improvement	MD	MD	MD^b	95%CI	p-Value
Week 4	−0.70	−0.50	−0.20	−1.37; 0.97	.74
Week 8	−0.90	−0.10	−0.80	−2.04; 0.44	.21
Recommended treatment duration^a	−0.90	0.10	−1.00	−2.20; 0.20	.10

Cal/BDP: calcipotriene and betamethasone dipropionate; DLQI: Dermatology Life Quality Index; MD: mean difference; vs.: versus; 95%CI: 95% confidence interval.

^a8 weeks for Cal/BDP cream and gel and 4 weeks for Cal/BDP foam.

^bMD values with negative sign imply greater DLQI improvement for Cal/BDP cream than Cal/BDP foam.

Table 8. Indirect comparison of treatment satisfaction^a in week 1 between Cal/BDP cream and foam with the common comparator Cal/BDP gel.

	Cal/BDP cream vs. gel^b	Cal/BDP foam vs. gel^23^,^38	Cal/BDP cream vs. foam
	MD	MD	MD^c	95%CI	p-Value
Ease of application
PTCS Q1	0.20	−0.90	1.10	0.61; 1.59	<.001
TPUQ Q1	0.09	−0.40	0.49	0.27; 0.71	<.001
Not greasy v1
PTCS Q2	0.90	−0.68	1.58	0.88; 2.27	<.001
TPUQ Q16	0.40	−0.30	0.70	0.39; 1.01	<.001
Not greasy v2
PTCS Q4	0.90	−0.68	1.58	0.88; 2.27	<.001
TPUQ Q16	0.40	−0.30	0.70	0.39; 1.01	<.001
Felt moisturizing
PTCS Q3	0.40	−0.22	0.62	0.14; 1.11	.01
TPUQ Q15	0.18	−0.10	0.28	0.06; 0.49	.01
Easily incorporated into daily routine
PTCS Q5	0.20	−0.23	0.43	−0.03; 0.88	.07
TPUQ Q9	0.09	−0.10	0.19	−0.01; 0.39	.07
Overall treatment satisfaction
PTCS Q6	0.40	−0.22	0.62	0.13; 1.12	.01
TPUQ Q26	0.18	−0.10	0.28	0.06; 0.50	.01

Cal/BDP: calcipotriene and betamethasone dipropionate; MD: mean difference; PTCS: Psoriasis Treatment Convenience Scale; Q#: question number; TPUQ: Topical Product Usability Questionnaire; v#: version number; vs.: versus; 95%CI: 95% confidence interval.

^aTreatment satisfaction measured with PTCS in the Cal/BDP cream studies³⁰ and TPUQ in the Cal/BDP gel PSO-INSIGHTFUL study.

^b Data on file.

^cMD values with positive sign imply greater treatment satisfaction for Cal/BDP cream than Cal/BDP foam.

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Data availability statement

The datasets generated and/or analyzed during the current study are not publicly available due to privacy reasons.