Among nearly 20 different active ingredients and treatment combinations, the topical triple-active fixed-dose combination gel (FDC) was found to be the most effective against moderate to severe acne.
The researchers who conducted the systematic review and network meta-analysis included 85 studies in their review. Topical triple FDC gel (clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1%) and combinations of dual-agent topical fixed-dose treatments and oral antibiotics (TOA3) consistently ranked in the top three.
The analysis, published in Journal of Drugs in Dermatologywas conducted by an international team of researchers based primarily in Canada and the United States. The following excerpts from the article have been edited for length and clarity.
What was the impetus for this investigation?
Guidelines from the United States, Canada and Europe recommend topical combination treatments considering oral medications as first-line treatment for moderate to severe acne. Topical benzoyl peroxide, topical retinoids, topical antibiotics and systemic medications are all effective, but there is confusion about which is most effective, the researchers wrote.
Four existing systematic literature reviews and network meta-analyses have examined the relative effectiveness of numerous acne treatments. Two of these were specifically targeted at patients with mild to moderate acne, while the other two included patients with acne of any severity. No previous analysis had looked at patients with moderate to severe acne, the researchers wrote, despite this subgroup bearing a greater disease and economic burden.
Therefore, the present analysis evaluated the relative effectiveness of available treatments for moderate to severe acne.
Which treatments were included in the current analysis?
The researchers considered several treatment categories based on guidelines from the American Academy of Dermatology.
First, the researchers included monotherapies, including topical (benzoyl peroxide, antibiotics or retinoids) and oral (antibiotics, retinoids, spironolactone or contraceptives).
The second category included various combination treatments, including fixed-dose topical three-drug FDC gel, dual-drug topical FDCs, pharmacological and physical treatment combinations, and various other topical and oral therapies.
A third category included exclusively physical treatments, including chemical peels, comedone removal, photothermal and photochemical therapies, photodynamic therapy, photopneumatic therapy and radiofrequency therapy.
A final category included metformin and combined oral contraceptives.
What were the key findings?
There was a 90% or greater probability that the triple-agent FDC gel was the most effective treatment for each outcome evaluated in the analysis.
TOA3 was numerically superior to triple-agent FDC gel in reducing inflammatory and non-inflammatory lesions.
What are the key messages?
The research team concluded that topical FDC gel with three active ingredients is superior to all treatments for moderate to severe acne. Its use makes it possible to reduce the need for oral antibiotics, thus minimizing the risk of antibiotic resistance.
The results also indicate that the addition of an oral antibiotic to a dual-agent FDC gel does not provide significant benefits compared to a triple-agent FDC gel.
Members of the research team disclosed numerous relevant financial relationships with industry.
