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Vitamin B12ointment Containing Avocado Oil in the Therapy of Plaque

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Vitamin B12ointment Containing Avocado Oil in the Therapy of Plaque A Service of Leibniz-Informationszentrum econstor Wirtschaft Leibniz Information Centre Make Your Publications Visible. zbw for Economics Stücker, Markus; Memmel, Ulrike; Hoffmann, Matthias; Hartung, Joachim; Altmeyer, Peter Working Paper Vitamin B12 ointment containing avocado oil in the therapy of plaque psoriasis Technical Report, No. 2001,27 Provided in Cooperation with: Collaborative Research Center 'Reduction of Complexity in Multivariate Data Structures' (SFB 475), University of Dortmund Suggested Citation: Stücker, Markus; Memmel, Ulrike; Hoffmann, Matthias; Hartung, Joachim; Altmeyer, Peter (2001) : Vitamin B12 ointment containing avocado oil in the therapy of plaque psoriasis, Technical Report, No. 2001,27, Universität Dortmund, Sonderforschungsbereich 475 - Komplexitätsreduktion in Multivariaten Datenstrukturen, Dortmund This Version is available at: http://hdl.handle.net/10419/77100 Standard-Nutzungsbedingungen: Terms of use: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Documents in EconStor may be saved and copied for your Zwecken und zum Privatgebrauch gespeichert und kopiert werden. personal and scholarly purposes. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle You are not to copy documents for public or commercial Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich purposes, to exhibit the documents publicly, to make them machen, vertreiben oder anderweitig nutzen. publicly available on the internet, or to distribute or otherwise use the documents in public. Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, If the documents have been made available under an Open gelten abweichend von diesen Nutzungsbedingungen die in der dort Content Licence (especially Creative Commons Licences), you genannten Lizenz gewährten Nutzungsrechte. may exercise further usage rights as specified in the indicated licence. www.econstor.eu Topical vitamin B12 in the therapy of plaque psoriasis 1 9LWDPLQ%RLQWPHQWFRQWDLQLQJDYRFDGRRLO LQWKHWKHUDS\RISODTXHSVRULDVLV Markus Stücker1, Ulrike Memmel1, Matthias Hoffmann1, Joachim Hartung2, Peter Altmeyer1 1 Department of Dermatology and Allergology, Ruhr University, Bochum (Director: Prof. Dr. Peter Altmeyer) 2 Department of Statistics of the University of Dortmund and project 'Meta-Analysis in Biometry and Epidemiology', SFB 475 of the DFG 7RDSSHDULQ '(50$72/2*< &RUUHVSRQGHQFH'U0DUNXV6WFNHU&OLQLFIRU'HUPDWRORJ\DQG$OOHUJRORJ\5XKU 8QLYHUVLW\%RFKXP*XGUXQVWUDVVH'%RFKXP*HUPDQ\7HO )D[(PDLO06WXHFNHU#GHUPDGH Topical vitamin B12 in the therapy of plaque psoriasis 2 6XPPDU\ Background: There are already many effective topical therapies available for use in the treatment of chronic plaque psoriasis. Unfortunately, these treatments are often associated with a not insignificant risk of undesirable effects. Objective and methods: In the randomized, prospective clinical trial discussed in the following, the therapeutic effects of the standard vitamin D3 analog calcipotriol were evaluated against those of a recently developed vitamin B12 ointment containing avocado oil preparation in an intraindividual right/left-side comparison. The efficacy of vitamin B12 in the treatment of psoriasis has already been demonstrated. The trial collective consisted of 13 patients, ten men and three women, with chronic plaque psoriasis. The observation period was 12 weeks; the effects of therapy were assessed on the basis of a PASI score adapted to the right/left-side comparison technique, the subjective evaluations of the investigator and patients and the results of 20 MHz sonography. Results: There was more rapid development of beneficial effects with use of calcipotriol in the initial 8 weeks, although differences in effects were significant only at the time point therapy week 8 (p<0.05). After 12 weeks, neither the PASI score nor 20 MHz sonography showed significant differences between the two treatments. While the efficacy of the calcipotriol preparation reached a maximum in the first 4 weeks and then began subsequently to subside, the effects of the vitamin B12 ointment containing avocado oil remained at a constant level over the whole observation period. This would indicate that the vitamin B12 preparation containing avocado oil may be suitable for use in long term therapy, a hypothesis further supported by the fact that the investigator and patients assessed the tolerability of the vitamin B12 ointment containing avocado oil as significantly better in comparison with that of calcipotriol. Conclusion: The results of this clinical trial provide evidence that the recently developed vitamin B12 ointment containing avocado oil has considerable potential as a well tolerated, long term topical therapy of psoriasis. Key words: Psoriasis, Vitamin B12 ointment containing avocado oil, Calcipotriol Topical vitamin B12 in the therapy of plaque psoriasis 3 ,QWURGXFWLRQ Many effective preparations for use in the topical therapy of psoriasis are currently available. In addition to the antipsoriatics dithranol, topical retinoids and corticosteroids, which have long been established as the standard therapeutic agents, vitamin D3 analogs are being increasingly used in the topical therapy of psoriasis. One factor that is common to these topical agents is a significant potential for causing irritation (1). It has proved possible to reduce the risk of such undesirable effects by combining various topical agents or topical and systemic antipsoriatics and, at the same time, to reduce the costs of treatment (2,3,4). An unfavorable benefit/side-effect profile will reduce compliance in patients who are already experiencing marked deterioration of quality of life as a result of psoriasis. For this reason, it is a recognized need to find topical antipsoriatics with a more positive side-effect profile. An exploratory investigation of the effects of an innovative vitamin B12 ointment containing avocado oil was conducted in the clinical trial discussed in this article. Initial reports of therapeutic success after (mainly) parenteral administration of vitamin B12 in the treatment of psoriasis were made some 40 years ago. Ruedeman et al. administered 1100 µg vitamin B12 i.m. daily over a period of 10 - 20 days in 34 patients with psoriasis vulgaris. There was complete remission in 11 cases, near complete remission in a further 11 cases, and significant improvement in symptoms in six cases (5). Cohen reported on psoriasis patients who had received 1000 µg vitamin B12 i.m. daily on 6 days per week over a 3-week period. In at least 50% of this collective, complete or near complete healing was achieved (6). It can be assumed that the effects of the substance in the skin after systemic administration of vitamin B12 are relatively slight, as up to 90% of a dose is eliminated by the renal pathway within 48 hours and is therefore not available to the target Topical vitamin B12 in the therapy of plaque psoriasis 4 organ – the skin (7). With topical application, the excellent depot characteristics (8) of the skin ensure that a large percentage of the vitamin B12 present in the ointment base remains continuously available. The fact that dermal vitamin B12 levels are reduced in psoriatic plaques and in apparently healthy skin in patients with psoriasis (9) is a reason for the use of vitamin B12 in psoriasis. Any new antipsoriatic agent should exhibit innovative activity and a favorable cost- benefit profile while the recurrence rate should be low after discontinuation of therapy with the agent. The therapeutic efficacy should not be less than that of standard topical antipsoriatics. As the basic efficacy of vitamin B12 in the treatment of psoriasis has already been demonstrated, the aim of the clinical trial discussed here was to investigate whether the therapeutic effects of the new vitamin B12 ointment containing 1 2 avocado oil differ from those of a contemporary vitamin D3 analog, calcipotriol . The therapeutic effects were evaluated in a randomized, prospective clinical trial in an intraindividual right/left-side comparison. 3DWLHQWVDQGPHWKRGV 3DWLHQWFROOHFWLYH Included in the trial were 13 patients with stable psoriasis vulgaris; ten men and three women aged 38 - 67 years (52.9 ± 12.2 years). Mean duration of the disorder was 20.8 ± 12.7 years. Two patients were excluded from the analysis due to deviations from the trial protocol; one female patient who exhibited insufficient compliance by occasionally discontinuing use of the ointment and receiving intensive UV irradiation, and one male patient who applied calcipotriol to the skin sites allocated to vitamin B12 1 Regividerm, Regeneratio AG, Wuppertal, Germany 2 Psorcutan ointment, Schering AG, Berlin, Germany Topical vitamin B12 in the therapy of plaque psoriasis 5 ointment containing avocado oil. Exclusion criteria were use of corticosteroids, topical retinoids, dithranol or vitamin D3 analogs in the 7 days prior to commencement of the trial, modification of systemic therapy in the past 3 months or phototherapy during the past 6 weeks, the presence of pustular or erythrodermic forms of psoriasis or age less than 18 or greater than 70 years. Prior to inclusion, it was established that patients had no known hypersensitivity to calcipotriol or to vitamin B12. Other exclusion criteria were avocado oil allergy and ≥60% of body surface area requiring treatment on one side of the body (a contraindication for the use of calcipotriol). The trial medication vitamin B12 – avocado
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