***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Acitretin , the principal and free acid metabolite of etretinate , was used to treat patients with stable , plaque-type psoriasis . For the first 8 weeks , 38 patients received placebo or acitretin  , 10 , 25 , 50 , or 75 mg daily , in a double-blind manner . After the double-blind phase , the patients were allowed to continue for a total of 6 months of acitretin therapy at an average dosage of 50 mg/day . When the patients flared after stopping therapy , an additional 6-month course of acitretin therapy was offered . Acitretin , which was as effective as etretinate , had to be given at a dosage of 50 mg/day or more to obtain a significant benefit . Side effects frequently occurred in patients receiving acitretin , 25 mg/day or more , but were generally mild and did not warrant discontinuation of therapy . They were similar to those of etretinate therapy  ; cheilitis , peeling of palms and soles , and alopecia occurred most frequently . The most common abnormal laboratory test results were elevations in serum triglycerides and , to a lesser extent , serum cholesterol and liver transaminase levels .  Acitretin , in view of its much shorter half-life and similar efficacy and side-effect profile compared with etretinate , may be a preferable therapy for psoriasis , especially in women of childbearing age Acitretin , the active metabolite of etretinate , has the clinical advantage of a much shorter terminal elimination half-life . We report the results of a double-blind , placebo-controlled trial of acitretin ( Soriatane ) in 15 patients with moderate to severe psoriasis . Patients received 25 mg or 50 mg daily of acitretin or placebo in a double-blind fashion for 8 weeks and then were given 25 to 75 mg acitretin daily during an open study . Only two placebo patients completed the double-blind phase ; one patient 's psoriasis worsened , and one showed no significant change . All 15 patients then completed at least 8 weeks with 25 to 75 mg acitretin daily , with a moderate change in erythema , scaling , and in duration ( mean 28 % to 37 % improvement ) but with minimal change in the percentage of body surface area involved . Prolonged treatment ( greater than or equal to 20 weeks ) with acitretin result ed in further significant improvement and a 44 % reduction of involved surface area from baseline Acitretin , a metabolite of etretinate , was given to 38 patients for the treatment of psoriasis .  During the first 8 weeks patients received either placebo , 10 mg , 25 mg , 50 mg , or 75 mg of acitretin daily in a double-blind manner . The dosages of 10 mg and 25 mg daily did not achieve any statistically significant improvement in psoriasis over placebo ; however , both the 50 and 75 mg dosages were statistically significantly better than placebo .  Side effects were primarily mucocutaneous and occurred in most patients receiving 25 mg or more of acitretin daily . After the double-blind period , patients continued treatment in an open fashion until they had received a total of 24 weeks of acitretin therapy . Most patients received 50 mg of acitretin daily , which adequately cleared their psoriasis . After approximately 3 months without acitretin , most patients required retreatment . Subsequent 24-week courses of therapy were generally effective and well tolerated . The most common laboratory abnormalities were elevations of triglyceride , cholesterol , and liver transaminase levels . The efficacy and side effects of acitretin appear to be similar to those of etretinate ; the principal advantage of acitretin is its shorter half-life . Although acitretin is a potent teratogen , its rapid elimination makes it a viable treatment for psoriasis among women of childbearing potential BACKGROUND Psoriasis vulgaris may benefit from treatment with fumaric acid and /or its derivatives ; however , because different preparations have been used , results have been contradictory and difficult to interpret . OBJECTIVE The purpose of this clinical trial was to evaluate the therapeutic value of fumaric acid derivatives . METHODS A r and omized double-blind study was carried out in patients with psoriasis , comparing a well-characterized formulation of fumaric acid derivatives with placebo . RESULTS The results indicated statistically significant superiority of the fumaric acid derivatives over placebo .  Adverse events ( flush , gastrointestinal disturbances ) were initially relatively frequent , but decreased thereafter . CONCLUSION Fumaric acid derivatives were found to be effective and safe in the treatment of psoriasis In a 4-month double-blind study the effects of dimethylfumaric acid esters ( DMFAE-EC ) and DMFAE plus salts of monoethylfumaric acid esters ( fumaric acid combination , FAC-EC ) in enteric-coated tablets were compared in 22 respectively 23 patients with psoriasis . In both groups about 50 % showed a considerable improvement , i.e. the initial score was more than halved . The therapeutic effects showed no significant differences in both groups with respect to the total psoriasis score or the different parameters . In the FAC-EC group the effects were obtained more rapidly . Most frequently observed side effects in both groups were flushings , stomachache and diarrhea . Due to these complaints 3 respectively 8 patients discontinued therapy . Eosinophilia , leukopenia and lymphopenia were the most frequently observed differences in lab tests . It was concluded that FAC-EC had no significantly better effect than monotherapy with DMFAE-EC . Moreover , enteric coating of the tablets did not prevent stomach complaints . Until more information has been obtained about the pharmacokinetics , the toxicity and optimal composition of the drug , the fumaric acid therapy in psoriasis should be seen as experimental Background : Calcipotriol is an established topical therapy for psoriasis vulgaris . Objective : This study aim ed to investigate whether the addition of calcipotriol to fumaric acid ester ( FAE ) monotherapy had an additive efficacy and an FAE-sparing effect in patients with severe plaque psoriasis . Methods : This multicentre , r and omised , double-blind , vehicle-controlled study included 143 patients for up to 13 weeks treatment . Group A received FAE tablets ( Fumaderm ® ) with an increasing daily dosage from 105 to 1,075 mg + ointment vehicle . Group B received FAE tablets + calcipotriol ointment ( 50 µg/g ) . Ointments were applied twice daily . Clinical response was assessed using percentage changes in the Psoriasis Area and Severity Index ( PASI ) , from baseline to treatment end . Results : The mean percentage change in the PASI was –76.1 % in group B and –51.9 % in group A , the difference between treatments was –24.2 % ( 95 % CI from –34.2 to –14.2 % ; p < 0.001 ) . Group B responded more rapidly to treatment . Investigators ’ and patients ’ overall efficacy assessment s were significantly more favourable for group B ( p ≤ 0.001 ) . Group B was prescribed less FAE than group A. This difference was greatest at the last visit ( mean daily dose 529 and 685 mg , respectively ; p = 0.006 ) . Overall adverse events in the two groups were similar . Conclusion : This study shows that the combination of calcipotriol and FAEs is significantly more effective and faster acting than FAE monotherapy in the treatment of severe plaque psoriasis . The combination has a slight FEA-sparing effect and therefore a superior benefit/risk ratio 
    Output:
    
One head‐to‐head study of very low‐ quality evidence comparing FAEs with methotrexate reported comparable efficacy and dropout rates , although FAEs caused more flushing .