Bulletin 90. Dovobet® in psoriasis are thepreferredchoice formaintenancetreatment. Vitamin Danalogues(calcipotriol, calcitriol,tacalcitol)are usedformosttypesofpsoriasisand Background (Dovobet®) andvitamin Danalogue preparations inadults. Table 1provides acomparisonoflicensed indicationsandcostof calcipotriol/betamethasone or vitaminD analoguesmay beneededtomaintain controlofpsoriasis inbetweentreatment. After a4weektreatment periodwithDovobet®, furthertreatmentwith coaltar, calcipotriol are unlikely tobeeffective ifthepersonhasgreaterthan10%ofbody surfaceaffected. combination ofcalcipotriol 50mcgandbetamethasonedipropionate0.5mg/g. Topical treatments Recommendations duration of treatmentofDovobet®. psoriasis. QIPPprojectsinthisareaareaimedatreviewing theappropriateuseand This briefingfocusesoncalcipotriol/betamethasone(Dovobet®) forthetreatmentof Calcipotriol/betamethasone (Dovobet®) inpsoriasis • • • • • • Patient educationandadherencetotreatmentisacrucialpartofmanagement. A 50%reductioninprescribingacrossEngland could resultinpotentialannualsavings of NICE statesthatDovobet® shouldonlybeusedforup to4weeks. Across England,£28.7million(ePACT Oct-Dec2014)isspentannually onDovobet® preparations. Savings Dovobet® isrecommendedasa4 table 1). ointment istheleastexpensive vitaminDanaloguepreparation ifcalculatedusingthemaximumdailyapplicationover afourweekperiod(see initiation shouldberestrictedtosecondarycare. Educating thepatientabouttheirconditionandensuringadherencetotreatmentformsacrucial partofmanagement. not beroutinelyaddedtorepeatprescribinglists. Dovobet® Dovobet® shouldnotbeusedfortheface,flexures orgenitalsinadultschildren. Dovobet® gelisrecommendedasa3 patients withchronicplaquepsoriasis. Vitamin Danaloguemonotherapy (calcipotriol, calcitriol,tacalcitol)orcorticosteroidtherapy arefirstlinetreatmentsforthemajorityof shouldonlybeusedoncedailyandforamaximumduration of4weeks th linetreatmentfortrunkandlimbpsoriasisinadults,useisnotrecommendedchildrenoradolescents. rd 1 linetreatmentforscalppsoriasisinadultsandchildrenoradolescents.Useisunlicensed and Calcitriolointmentistheleastexpensive vitaminDanaloguebasedoncostpergram. Calcipotriol 1,2 Dovobet® ointmentandgelcontain a 1 1 1

1 and shouldonlybeprescribedasacutetreatment.It £9 millionor£15,987per100,000patients. dovobet-in-psoriasis http://www.prescqipp.info/resources/viewcategory/326- Additional resourcesavailable: http://www.patient.co.uk/health/psoriasis-leaflet on topicaltreatments inpsoriasis) information-leaflets (scrolldown fortheinformation http://www.bad.org.uk/for-the-public/patient- ashx?id=123&itemtype=document or http://www.bad.org.uk/shared/get-file. Patient informationleafletsareavailable from: Bulletin Data pack 1 resources Implemention 1 Bulletin 90. Dovobet® in psoriasis

5. 4. 3. 2. 1. References Table 1:Comparisonoflicensedindications,dosageandcostcalcipotriol/betamethasonevitaminDpreparations inadults. Product 0.005%/0.05% (Dovobet®) Calcipotriol/Betamethasone Ointment Calcitriol 3microgram/g ointment(Silkis®) Calcipotriol 50micrograms/ml scalpsolution (Dovobet®) Calcipotriol/Betamethasone Gel0.005%/0.05% Calcipotriol 50microgram/g ointment (Dovonex®) Tacalcitol 4microgram/g ointment(Curatoderm®) Tacalcitol 4microgram/g lotion(Curatoderm®) Haymarket Publishing,London. MIMS.January2015. www.mims.co.uk Accessedon23/1/15 on 23/1/15 Prescription PricingDivision (PPD). NHSBusinessServicesAuthority. DrugTariff. January2015.http://www.ppa.org.uk/ppa/edt_intro.htm Accessed British NationalFormulary. November 2014.http://www.medicinescomplete.com Accessedon16/11/14 NICE ClinicalKnowledgeSummaries.Psoriasis. LastupdatedDecember2012.Available viawww.cks.nhs.uk/psoriasis Accessed26/9/14. http://www.nice.org.uk/guidance/cg153 Accessed24/9/14 National InstituteforHealthandCareExcellence (NICE).ClinicalGuideline,153.Theassessment andmanagementofpsoriasis.October2012.Available Licensed indicationinadults Yes psoriasis scalp” plaque moderate “non Mild to Yes No Yes Yes Yes Yes No psoriasis Scalp No Yes No Yes No No Dosage Daily daily Twice daily Twice daily twice Once or Daily Daily Daily 3 daily quantity recommended Maximum 60ml/weekly* psoriasis: 15g Stable plaque 100g/week Scalp: 1-4g 10ml 15g 30g 10g 3 sized tube) cost effective (using most Cost/g orml 90p/ml 43p/ml 22p/g 55p/g 63p/g 18p/g 31p/g 4,5 sizes) the mostcosteffective tube licensed indications(using recommended dosesfor Cost/4 weeksatmaximum 4,5 Plaque -£231.56 Scalp -£61.75 £215.42 £266.28 £151.70 £118.81 £88.67 £86.41