Table 3, Key Characteristics of HP/TAZ and Other Relevant Topical Therapies for the Treatment of Plaque Psoriasis - Clinical Review Report: Halobetasol Propionate and Tazarotene (Duobrii)

	HP/TAZ (Duobrii)	Topical corticosteroids (e.g., betamethasone, mometasone, clobetasol propionate)	Vitamin D analogues (e.g., calcitriol, calcipotriol)	Retinoids (e.g., tazarotene 0.05% and 0.1% w/w)	Combination treatments (e.g., betamethasone/calcipotriene, calcipotriol/betamethasone)
Mechanism of action	HP is a superpotent topical corticosteroid with anti-inflammatory, antipruritic, and vasoconstrictive actions TAZ is a retinoid prodrug that reduces cell proliferation and hyperplasia, and suppresses high levels of inflammatory markers in psoriatic epidermis	Via multiple mechanisms, act as an anti-inflammatory and immune suppressant	Calcipotriol is a nonsteroidal antipsoriatic agent that, like the active form of vitamin D, regulates cell proliferation and differentiation	Oral retinoids are thought to modulate keratinocyte proliferation and differentiation in addition to having anti-inflammatory effects⁴	Combination of calcipotriol hydrate as a synthetic vitamin D analogue and betamethasone propionate (corticosteroid)
Indication^a	For improving the signs and symptoms of plaque psoriasis in adult patients with moderate-to-severe plaque psoriasis	Symptomatic relief of acute and chronic skin eruptions, where anti-inflammatory, anti-allergenic, and antipruritic activity is required Topical corticosteroids are widely used for many other causes of skin inflammation	Topical treatment of psoriasis Combination use with a moderate to very potent topical corticosteroid, cyclosporin A, or acitretin	Topical treatment of plaque psoriasis	Topical treatment of psoriasis vulgaris in adults
Route of administration	Topical (lotion)	Topical	Topical (available as a cream, ointment, and scalp solution)	Topical (gel or cream)	Topical (available as a gel, ointment, foam)
Recommended dose	Applied in a thin layer to the affected area once a day	Varies between drugs	Varies between drugs	Applied in a thin layer to affected area once a day	Varies between drugs
Serious adverse effects or safety issues	Reversible HPA axis suppression Infection Contraindicated in pregnant women, those who are hypersensitive, with viral skin lesions or skin infections, and seborrheic dermatitis	If used under an occlusive dressing, particularly over extensive areas, or on the face, scalp, axilla(e), scrotum, or when applied to the genitourinary tract or oral mucosa, or when administered rectally, sufficient absorption may take place to give rise to adrenal suppression and other systemic effects Children may be at greater risk of developing systemic complications with the use of topical corticosteroids	Carcinogenesis, serum calcium abnormalities, and renal impairment Contraindicated in patients with: hypersensitivity to drug or formulation hypercalcemia systemic treatment of calcium homeostasis renal impairment or ESRD liver dysfunction	Skin irritation Contraindicated in patients with hypersensitivity to retinoic compounds, patients with seborrheic dermatitis, and pregnant women	Safety issues are similar to those listed for topical corticosteroids and vitamin D analogues
Other	Not recommended for use on face, scalp, axillae, or intertriginous areas Not to be used on eczematous skin or with occlusive dressings		Should not be applied to the eyes, lips, or facial skin (Silkis)		Calcipotriol/betamethasone is not recommended for use on face, axillae, flexures, groin, or genitals

HP/TAZ (Duobrii)

Topical corticosteroids (e.g., betamethasone, mometasone, clobetasol propionate)

Vitamin D analogues (e.g., calcitriol, calcipotriol)

Retinoids (e.g., tazarotene 0.05% and 0.1% w/w)

Combination treatments (e.g., betamethasone/calcipotriene, calcipotriol/betamethasone)

Mechanism of action

HP is a superpotent topical corticosteroid with anti-inflammatory, antipruritic, and vasoconstrictive actions

TAZ is a retinoid prodrug that reduces cell proliferation and hyperplasia, and suppresses high levels of inflammatory markers in psoriatic epidermis

Via multiple mechanisms, act as an anti-inflammatory and immune suppressant

Calcipotriol is a nonsteroidal antipsoriatic agent that, like the active form of vitamin D, regulates cell proliferation and differentiation

Oral retinoids are thought to modulate keratinocyte proliferation and differentiation in addition to having anti-inflammatory effects⁴

Combination of calcipotriol hydrate as a synthetic vitamin D analogue and betamethasone propionate (corticosteroid)

Indication^a

For improving the signs and symptoms of plaque psoriasis in adult patients with moderate-to-severe plaque psoriasis

Symptomatic relief of acute and chronic skin eruptions, where anti-inflammatory, anti-allergenic, and antipruritic activity is required

Topical corticosteroids are widely used for many other causes of skin inflammation

Topical treatment of psoriasis

Combination use with a moderate to very potent topical corticosteroid, cyclosporin A, or acitretin

Topical treatment of plaque psoriasis

Topical treatment of psoriasis vulgaris in adults

Route of administration

Topical (lotion)

Topical

Topical (available as a cream, ointment, and scalp solution)

Topical (gel or cream)

Topical (available as a gel, ointment, foam)

Recommended dose

Applied in a thin layer to the affected area once a day

Varies between drugs

Applied in a thin layer to affected area once a day

Varies between drugs

Serious adverse effects or safety issues

Reversible HPA axis suppression Infection

Contraindicated in pregnant women, those who are hypersensitive, with viral skin lesions or skin infections, and seborrheic dermatitis

If used under an occlusive dressing, particularly over extensive areas, or on the face, scalp, axilla(e), scrotum, or when applied to the genitourinary tract or oral mucosa, or when administered rectally, sufficient absorption may take place to give rise to adrenal suppression and other systemic effects

Children may be at greater risk of developing systemic complications with the use of topical corticosteroids

Carcinogenesis, serum calcium abnormalities, and renal impairment Contraindicated in patients with:

hypersensitivity to drug or formulation
hypercalcemia
systemic treatment of calcium homeostasis
renal impairment or ESRD
liver dysfunction

Skin irritation

Contraindicated in patients with hypersensitivity to retinoic compounds, patients with seborrheic dermatitis, and pregnant women

Safety issues are similar to those listed for topical corticosteroids and vitamin D analogues

Other

Not recommended for use on face, scalp, axillae, or intertriginous areas

Not to be used on eczematous skin or with occlusive dressings

Should not be applied to the eyes, lips, or facial skin (Silkis)

Calcipotriol/betamethasone is not recommended for use on face, axillae, flexures, groin, or genitals

From: Introduction

Cover of Clinical Review Report: Halobetasol Propionate and Tazarotene (Duobrii)

Clinical Review Report: Halobetasol Propionate and Tazarotene (Duobrii): (Bausch Health, Canada Inc.): Indication: Psoriasis, moderate-to-severe plaque [Internet].

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2020 Dec.

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Table 3Key Characteristics of HP/TAZ and Other Relevant Topical Therapies for the Treatment of Plaque Psoriasis