INDIVIDUAL ARTICLE: Fixed Combination Calcipotriene/Betamethasone (Cal/BDP) Cream: Evaluating the Role of Polyaphron Dispersion (PAD) Technology in Psoriasis Treatment

August 2023 | Volume 22 | Issue 8 | SF381621s5 | Copyright © August 2023


Published online July 22, 2023

Rasika Reddy BAa, Samiya Khan BSa, Leon Kircik MDb, April W. Armstrong MD MPHa

aDepartment of Dermatology, University of Southern California, Los Angeles, CA 
bIcahn School of Medicine at Mount Sinai, New York, NY; Physicians Skin Care, PLLC, Louisville, KY;  
DermResearch, PLLC, Louisville, KY; Skin Sciences, PLLC, Louisville, KY 

Abstract
Most patients with plaque psoriasis exhibit mild-to-moderate disease and topical therapies remain the mainstay treatment option for these patients. The use of topical steroids in combination with vitamin D analogs can produce synergistic effects and minimize adverse effects. However, due to the incompatible pH ranges of topical steroids and vitamin D analogs, combination formulations can be difficult to manufacture. Until recently, only anhydrous formulations of these 2 agents were developed as foam, gel/suspension, and ointment. However, anhydrous vehicles can often result in greasy or oily skin, thus limiting treatment adherence. Recently, Polyaphron Dispersion (PAD) technology presents a new, more cosmetically appealing vehicle that allows for both topical steroids and vitamin D analogs to coexist in an aqueous environment, such as a cream formulation. The calcipotriene/betamethasone dipropionate (CAL/BDP) cream enhances drug delivery by reducing the greasy and oily side effects of anhydrous formulations. Phase 3 clinical trials have demonstrated CAL/BDP cream’s superior efficacy in treating psoriasis over gel/suspension, and the clinical trials have also shown significantly improved patient satisfaction with the cream formulation. 


 

INTRODUCTION

Psoriasis vulgaris is a chronic, immune-mediated skin disease originating from a combination of environmental and genetic factors. Approximately 80% of psoriasis patients exhibit mild-to-moderate disease, for which topical therapies remain the cornerstone of psoriasis management.2 The most common topical therapies include topical corticosteroids, vitamin D analogs (calcipotriene, calcipotriol), and retinoids (tazarotene). Current treatment guidelines have evolved to recommend the use of newer fixed-dose combinations of topical steroids (betamethasone dipropionate) and vitamin D analogs (calcipotriene) because the combination has demonstrated superior efficacy over monotherapy with either agent alone.2 In addition, the combination of CAL/BDP exhibits a more favorable safety profile than topical corticosteroids alone. Furthermore, topical CAL/BDP combination therapies have become increasingly popular because they fulfill many requirements that patients and dermatologists alike look for in topical management of psoriasis including faster onset of action, maximal and longer duration of efficacy, less frequent application, and improved quality-of-life metrics.3

Until recently, the 2 ingredients (topical steroids and topical vitamin D analogs) have been limited to non-aqueous vehicles due to their distinctive pH environments.4 The 2 are typically incompatible. To ensure compatibility, traditionally both agents have needed to coexist in non-aqueous environments. Currently, anhydrous formulations of CAL/BDP such as foam, gel/suspension, and ointment can result in undesired greasy or oily skin. PAD technology utilizes a newer vehicle to allow these two ingredients to coexist in an aqueous form. Thus, the PAD 
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