Maui Derm: 2020 will be ‘age of new acne drugs’

MAUI, HAWAII — Experts here at Maui Derm for Dermatologists 2020 discussed significant advances in acne therapies for patients aged 9 years and older.

“2020 will be the year of new acne drugs,” Theodore Rosen, MD, professor of dermatology, Baylor College of Medicine, told attendees. “We have a bunch of new creams, lotions and a new molecule which are going to be exciting to use as acne treatments.”

The first treatment that Rosen and Neal Bhatia, MD, a dermatologist in private practice in California, discussed was Aklief (trifarotene, Galderma Laboratories). According to Rosen and Bhatia, this FDA-approved retinoid cream can be applied once daily.

“This drug showed very good efficacy in the trunk area,” Rosen added. He said trial data showed that 35.7% of those who received trifarotene had clear skin in the trunk at 12 weeks, vs. 25% who received placebo. In addition, 42.6% of those who received trifarotene had almost clear skin with a grade 2 improvement, also after 12 weeks, vs. 29.9% who received placebo.

Bhatia noted that trifarotene is a “brand new molecule for the receptor that’s common in acne,” adding that makes it a “significant improvement than many other acne treatments currently on the market.”

Altreno (tretinoin, Ortho Dermatologics) was the second treatment Rosen and Bhatia mentioned. This is an FDA-approved retinoid lotion that can be administered once daily. According to the speakers, studies showed that 16.5% of those who received Altreno had clear skin at 12 weeks, compared with 6.9% who received placebo. In addition, 19.8% of those who received this agent had almost clear skin with a grade 2 improvement, also after 12 weeks, compared with 12.5% who received placebo.

The third treatment discussed was Arazlo (tazarotene, Ortho Dermatologics). As with Altreno, Arazlo is an FDA-approved retinoid lotion that can be applied once daily. Rosen and Bhatia said trial data showed that 25.5% of those who received Arazlo had clear skin at 12 weeks, vs. 13% who received placebo. In addition, 29.6% of those who received this treatment option had almost clear skin with a grade 2 improvement, also after 12 weeks, vs. 17.3% who received placebo.
Rosen said that patients who received this treatment also experienced “a little bit of peeling and a little bit of redness.”

“Because this is a different sort of formulation, patients should experience less irritation,” Bhatia added. “If you look at the percentage of patients that experienced expected reactions when using this treatment, these are very small percentages. This changes the entire way we think of using this drug.”

Winlevi (clascoterone, Cassiopea), an androgen receptor inhibitor cream that can be administered twice daily, was the fourth treatment that Rosen and Bhatia discussed. Trials involving this treatment showed 16.1% of those who received clascoterone had clear skin at 12 weeks, compared with 7% who received placebo. In addition, 18.7% of those who received clascoterone had almost clear skin with a grade 2 improvement, also after 12 weeks, compared with 4.7% who received placebo. A New Drug Application for clascoterone is pending with the FDA, according to Bhatia.

The fifth treatment discussed, Amzeeq (minocycline, Foamix), is an FDA-approved, antibiotic foam that can be applied once daily.

“I am very, very concerned about antibiotic resistance,” Bhatia said. “But if you give a very low dose of this treatment, you're not killing much of anything resistant.”

He added that systemic adverse events tied to this treatment were minimal. “This looks like a nice addition to our armamentarium for acne.” – by Janel Miller

Reference: Bhatia N, Rosen T. New drugs and therapies: 2020. Presented at: Maui Derm for Dermatologists; Jan. 25-29, 2020; Maui, Hawaii.

Disclosures: Bhatia reports professional relationships with 12 companies including Almirall and Biofrontera. Rosen reports serving as a consultant to Ortho Derm and serving on the advisory board for Almirall and Foamix.

Editor's Note: This article was updated on January 29, 2020, to correctly identify the recommended doses of minocycline foam, tazarotene and tretinoin as once daily. The editors regret the error.