Ten RCTs were included in the review, with 6,341 participants (range 177 to 1,505). Eight RCTs apparently met all quality criteria, while two met all criteria apart from double-blinding.
When all direct and indirect comparisons were pooled, the two-compound formulation calcipotriol and betamethasone dipropionate gel was associated with a significantly higher response rate at four weeks than any other treatment, measured with either the Investigator Global Assessment (risk ratios ranging from 1.16 to 5.18) or Total Sign Score (risk ratios ranging from 1.29 to 13.79).
At up to eight weeks, two-compound formulation calcipotriol and betamethasone dipropionate gel was associated with: significantly lower rates of all adverse events than calcipotriol once or twice daily; fewer skin adverse effects than placebo, calcipotriol (once or twice daily) or calcipotriol with polytar; and fewer withdrawals due to adverse events than calcipotriol once or twice daily. For other adverse events, there was no significant difference between the two-compound gel and comparators.
The absolute response rate for two-compound formulation calcipotriol and betamethasone dipropionate gel using the Investigator Global Assessment was estimated at 60.33% (95% CI 57.9 to 62.7), while rates for comparators ranged from 11.7% to 53.3%. The absolute response rate for the two-compound gel using the Total Sign Score was estimated at 39.9% (95% CI 37.7 to 42.4), while rates for comparators ranged from 5.1% to 33.6%. The two-compound gel ranked first for every safety outcome apart from 'all adverse events', where it ranked third.
Full effect estimates and 95% confidence intervals were reported for all outcomes.