pulmicort and betamethasone-17-21-dipropionate

This pilot randomized intra-patient side to side trial was designed to assess the antipsoriatic efficacy, safety and tolerability of once daily versus the separate application of a vitamin D3 analogue and a powerful corticosteroid.. Twenty patients with plaque type psoriasis were enrolled. Two similar symmetrical lesions were randomized to be treated with an application of an ointment containing calcipotriol 50 µg/g plus betamethasone dipropionate 0.5 mg/g once daily or the application of budesonide 0.25 mg/g cream in the morning and tacalcitol 4 µg/g ointment in the evening.. Eighteen patients completed the study. Both treatments proved to be effective but budesonide cream and tacalcitol ointment gave a faster improvement of lesions and itching relief at t1 and were better tolerated.. The separate daily regimen may represent a suitable treatment option for patients who need a faster improvement and a better moisturizing activity. Further studies which compare the efficacy and safety of these regimens need to be developed.

Topics: Administration, Cutaneous; Adult; Aged; Betamethasone; Budesonide; Calcitriol; Dermatologic Agents; Dihydroxycholecalciferols; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Ointments; Pruritus; Psoriasis; Time Factors; Young Adult

Two clinical trials were carried out in order to study adrenal suppression in 6 patients with psoriatic erythroderma and in 28 patients with psoriasis treated with topical glucocorticosteroids. Betamethasone-17-valerate (0.1%), betamethasone-17,21-dipropionate (0.05%) and budesonide (0.025%) ointments were studied in erythroderma; betamethasone-17,21-dipropionate and budesonide in psoriasis. The erythroderma study was an open, crossover experiment; the psoriasis study was a double-blind, group-comparative study. Adrenal suppression was measured as plasma cortisol concentrations with and without ACTH stimulation. The depressive activity on the HPA-axis in increasing order was budesonide, betamethasone-17-valerate and betamethasone-17,21-dipropionate. The differences, however, did not reach statistically significant levels.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Betamethasone; Betamethasone Valerate; Budesonide; Clinical Trials as Topic; Dermatitis, Exfoliative; Female; Glucocorticoids; Humans; Male; Middle Aged; Pregnenediones; Psoriasis

A double-blind trial was carried out to compare the effectiveness of budesonide, a non-halogenated steroid, and betamethasone-17,21-dipropionate in the treatment of psoriasis. One group of 40 hospitalized patients was treated with both preparations under occlusive dressings. The evaluation was done as a left-right comparison within each patient. These patients were treated for 1 week, with evaluations on Days 3 and 7. Another series of 79 out-patients was divided into two groups, either group being treated with one of the two preparations. These were treated for 2 weeks, with evaluations after 1 and 2 weeks. Itching, scaling, erythema and induration were recorded on a 5-point scale. A preference was stated for the best result. Statistically significant results favouring the budesonide ointment were obtained, both with and without occlusion.

Topics: Adolescent; Adult; Aged; Betamethasone; Budesonide; Child; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Occlusive Dressings; Pregnenediones; Psoriasis

The systemic effect of the topical glucocorticoid ointments budesonide 0.025% (Preferid), hydrocortisone-17-butyrate 0.1% (Locoid) and betamethasone-17,21-dipropionate 0.5% (Diproderm) was studied in 9 healthy volunteers. Five g ointment was applied on about 13% of the total body surface, using occlusive technique for three consecutive nights. The cortisol values in plasma and urine were measured before, during, and 3 days after applications. Although budesonide and betamethasone-17,21-dipropionate are equipotent drugs from a therapeutic point of view, the halogenated betamethasone-17,21-dipropionate caused significantly greater decrease in both plasma- and urinary cortisol levels. Between the two non-halogenated glucocorticosteroids, budesonide and hydrocortisone-17-butyrate, no significant difference was found despite the large difference in anti-inflammatory effects. The results indicate that it is possible to improve the ratio between the local therapeutic effect and the systemic activity of a glucocorticosteroid. Budesonide represents such an improvement.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Betamethasone; Budesonide; Glucocorticoids; Humans; Hydrocortisone; Male; Occlusive Dressings; Ointments; Pregnenediones

The reported prevalence of allergic contact dermatitis from topical corticosteroids in clinical populations, in the period 1993-2002, varied from 0.55 to 5.98%. This study is a retrospective analysis of 1153 individuals undergoing routine patch testing in an Occupational Dermatology Clinic in Melbourne, Australia. We report a rate of 0.52% for positive patch test reactions to 5 corticosteroids. Corticosteroids tested were betamethasone-17-valerate, budesonide, Diprosone cream (betamethasone diproprionate 0.05%) (Essex-Pharma, a division of Schering-Plough Pty Ltd, Sydney, Australia), tixocortol-21-pivalate and triamcinolone acetonide. Population characteristics were described using the MOAHL (M = percentage of males tested; O = occupational; A = atopics; H = patients with hand eczema; L = patients with leg ulcers or stasis eczema) index. Prescribing patterns, rate of referral and rate of relevant positive patch test reactions were characterized for the region. These results were compared to the rates of corticosteroid allergy and patch testing methodologies from published international studies. It was noted that many high-sensitization potential corticosteroids were not available in our region. Although a low percentage of leg ulcers and stasis dermatitis may be associated with a lower rate of corticosteroid allergy, this association may be confounded by regional factors such as prescribing habits and the local availability of corticosteroids. We conclude that the low rate of topical corticosteroid contact allergy reported by our clinic is associated with regional availability and prescribing practices and the scarcity of stasis dermatitis and leg ulcers in our clinic population.

Topics: Administration, Topical; Adult; Australia; Betamethasone; Betamethasone Valerate; Budesonide; Dermatitis, Allergic Contact; Dermatitis, Occupational; Drug Utilization; Female; Glucocorticoids; Humans; Hydrocortisone; Male; Middle Aged; Patch Tests; Practice Patterns, Physicians'; Prevalence; Retrospective Studies; Triamcinolone Acetonide

A high potency at the application site and a low incidence of glucocorticoid side-effects form the desired profile of glucocorticosteroids for anti-inflammatory therapy. A new type of glucocorticosteroid 16,17-acetals with an improved topical/systemic activity ratio has been developed. Non-symmetric 16,17-acetal substitution increased the topical anti-inflammatory activity more than the systemic activity in rodents, whereas fluorine substitution in 9 alpha- or 6 alpha,9 alpha-positions increased the systemic more than the topical potency. The non-fluorinated, non-symmetric 16 alpha,17 alpha-acetal budesonide reached the highest ratio, which was five to ten times better than that of the earlier known 16,17-acetonides such as triamcinolone acetonide, or that of the 17 alpha-esters such as beclomethasone 17 alpha,21-dipropionate. Although budesonide and betamethasone 17 alpha,21-diproprionate have the same topical anti-inflammatory potency, the latter decreased plasma and urinary cortisol levels significantly more when ointment preparations were compared in volunteers. Budesonide is efficiently biotransformed in the liver to metabolites such as 6 beta-hydroxybudesonide and 16 alpha-hydroxyprednisolone, which are 50-100 times less potent than the parent steroid. In homogenates of rat or human adult livers budesonide is biotransformed two to five times more rapidly than desonide and triamcinolone acetonide.

Topics: Administration, Topical; Animals; Anti-Inflammatory Agents; Betamethasone; Betamethasone Valerate; Biotransformation; Budesonide; Dose-Response Relationship, Drug; Humans; Hydrocortisone; Liver; Male; Mice; Pregnenediones; Rats; Rats, Inbred Strains; Structure-Activity Relationship