Researchers name topical triple-agent fixed-dose combination gel best treatment for acne
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Key takeaways:
- Topical triple-agent fixed-dose combination had the best log-ratio for treatment success.
- It also proved to be the most tolerable with only 2.8% of patients discontinuing treatment due to adverse events.
Topical triple-agent fixed-dose combination gel outperformed other treatment options for moderate to severe acne, according to a study.
“Guidelines from the U.S., Canada and Europe recommend topical combination treatments, with consideration of oral drugs, as the first-line approach in moderate to severe acne,” Julie C. Harper, MD, president and owner of Dermatology & Skin Care Center of Birmingham and clinical associate professor at University of Alabama-Birmingham, and colleagues wrote. “Topical benzoyl peroxide (BPO), topical retinoids, topical antibiotics and systemic drugs are all effective, but there is a lack of clarity about the most efficacious acne treatment.”
Harper and colleagues conducted a systematic literature review comprised of 85 studies to determine the most effective and safest acne treatment for patients aged 9 years and older with moderate to severe facial acne. Efficacy outcomes were determined by the percentage of patients that achieved a 2-grade or more reduction from baseline and a clear or almost clear global severity score as well as absolute changes in inflammatory and noninflammatory lesion counts.
Results showed that the top three topical combinations for treatment success in acne were topical triple-agent fixed-dose combination (FDC) gel (clindamycin phosphate 1.2%/adapalene 0.15%/BPO 3.1%), combinations of double-agent FDC topical treatments with oral antibiotic (TOA3) and topical retinoid/BPO FDC (TFDCRB2).
Compared with vehicle or placebo, topical triple-agent FDC had a better log-odds ratio for treatment success than TOA3 (1.84; 95% credible interval [CrI], 1.36-2.29 vs. 1.69; 95% Crl, 1.01-2.32). However, TOA3 was numerically superior to the topical triple-agent FDC compared with vehicle or placebo when it came to the mean difference in reduction of inflammatory lesions (–10.4; 95% Crl, –13.44 to –7.14 and – 8.21; 95% Crl, –10.33 to –6.13, respectively) and noninflammatory lesions (–17.74; 95% Crl, –22.56 to –12.85 and – 13.41; 95% Crl, –16.69 to –10.32).
Topical triple-agent FDC gel was also well tolerated with only 2.8% of patients reporting discontinuations due to treatment-emergent adverse events. On the other hand, nearly 32% of patients treated with double-agent FDCs, such as TOA3, had treatment-related adverse events.
Taken altogether, the researchers determined that topical triple-agent FDC gel was the superior treatment option.
“FDC gel was the most efficacious treatment for each outcome,” Harper and colleagues wrote. “Collectively, these findings suggest that adding an oral antibiotic to topical double-agent FDC gel does not offer significant benefits compared with topical triple agent FDC gel.”
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