Pharmaceutical breakthroughs on horizon for acne, rosacea

MIAMI BEACH, Fla. — Many new products and emerging therapies are being studied in clinical trials to treat acne, rosacea and molluscum contagiosum, according to a presenter at South Beach Symposium.

The first emerging acne treatment that Leon H. Kircik, MD, clinical associate professor of dermatology at Indiana University School of Medicine and a dermatologist at Physicians Skin Care in Louisville, Kentucky, discussed was clascoterone. Clascoterone is a topical androgen receptor inhibitor that binds with the androgen receptors in the skin to avoid systemic adverse events. This showed a 16% to 19% improvement in Investigator’s Global Assessment from moderate or severe to clear or almost clear.

Another emerging treatment is trifarotene, a retinoid receptor gamma-agonist.

“I was very much excited to be a part of the clinical study for this one because regulators are important in acne. It’s the bread and butter of acne treatment,” Kircik said during his presentation. “However, when I saw the phase 3 clinical results, I’m not that excited anymore. I’m a little bit disappointed.”

The active arm in the trifarotene study showed the mean absolute inflammatory lesion counts were reduced by 19 and the vehicle arm showed a reduction of 15.4, so there was only a 3.6 difference. Mild to moderate adverse events for trifarotene included erythema, scaling, dryness, and stinging and burning.

Tazarotene was another treatment Kircik mentioned, but it has tolerability issues. In a new formulation of tazarotene, 0.05% vs. 1%, tolerability improved with no signs of erythema, scaling or dryness, with a 2.9% rate of stinging and burning.

Oxymetazoline, an alpha 1 adrenergic receptor agonist, has been discussed as causing rebound congestion in patients with rosacea.

“In experimental literature about rebound congestion and rhinitis medicamentosa, [researchers] found that it’s not the oxymetazoline that poses rebound with Afrin,” Kircik said. “It’s benzalkonium chloride, which is an inactive ingredient. It is not in our rosacea medication. It has nothing to do with us.”

According to Kircik, in a following study in which patients were instructed to inform their clinician if they experienced rebound or worsening symptoms after stopping Afrin, no patients showed any signs of rebound, which resolved concerns.

There are also emerging products and therapies for treating molluscum contagiosum. A topical terpenoid proprietary drug device combination of cantharidin, VP-102, has been studied. The administration of this drug is through a single-use precision applicator with bittering agents to reduce oral ingestion by children. VP-102 shows complete clearance in patients with molluscum contagiosum.

“We look at the overall numbers of all molluscum, and it’s about 69% to 83% reduction,” Kircik said. “This is very exiting that finally we have something to treat those with molluscum contagiosum in our offices.” – by Erin T. Welsh

Reference:

Kircik LH. Pharmaceutical breakthroughs and clinical trials update. Presented at: South Beach Symposium; Feb 6-9, 2020; Miami Beach, Florida.

Disclosure: Kircik reports he is affiliated with various companies, including Abbott, Acambis and Allergan.