Background: Several clinical trials have established the benefit of using a topical corticosteroid in conjunction with tazarotene gel in the treatment of plaque psoriasis. However, there is little information comparing the relative benefits of different corticosteroids, or different formulations of corticosteroids, when used adjunctively with tazarotene.
Objective: This study was designed to compare the clinical benefits achieved with each of six commonly prescribed high- or mid-high-potency corticosteroid creams and ointments applied in conjunction with tazarotene 0.1% gel in the treatment of patients with stable plaque psoriasis.
Methods: A 12-week, multicenter, investigator-masked, randomized, parallel-group study was performed with more than 200 patients who were randomly assigned to regimens of tazarotene 0.1% gel alone, tazarotene plus a high-potency topical corticosteroid (fluocinonide 0.05% ointment, mometasone furoate 0.1% ointment, or diflorasone diacetate 0.05% ointment), or tazarotene plus a mid-high-potency topical corticosteroid (betamethasone dipropionate 0.05% cream, fluticasone propionate 0.005% ointment, or diflorasone diacetate 0.05% cream). All medications were to be applied once daily: corticosteroids in the morning, tazarotene gel in the evening. At assessment visits, physicians made an overall evaluation of the patient's psoriasis and graded global improvement, plaque elevation, scaling, erythema, and pruritus. Patients also rated their treatment in terms of efficacy, tolerability, and satisfaction.
Results: The best-performing steroid was betamethasone dipropionate 0.05% cream (a mid-high-potency steroid), followed by mometasone furoate 0.1% ointment (a high-potency steroid) and diflorasone diacetate 0.05% ointment (a high-potency steroid). Maximum improvements were achieved within 8 weeks. The best-tolerated regimen was tazarotene plus mometasone furoate 0.1% ointment and the optimal balance between efficacy and tolerability was achieved with this regimen.
Conclusion: Some steroids are considerably more effective than others in optimizing the efficacy and tolerability of tazarotene therapy. With a suitable combination regimen, the duration of initial therapy (before maintenance therapy is started) need not be prolonged.