Newer Approaches in Topical Combination Therapy for Acne

Lisa W. Fu, BHSc; Ronald B. Vender, MD, FRCPC

Skin Therapy Letter. 2011;16(9)

Conclusion

Successful topical treatment of acne depends on appropriate agent selection based on patient-specific acne severity and tolerance, adherence, and adequate follow-up. The advent of combinational therapeutic products provide increased efficacy by targeting multiple pathophysiologic processes. Additional advantages of using combination therapy include reduced complexity of treatment regimen and convenient once-daily dosing. The future of topical acne treatment holds the promise of more novel uses of conventional anti-acne agents formulated with advanced vehicle delivery systems that offer less side-effects, increased tolerance, dosing simplicity, and improved efficacy.

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Table 1. Studies comparing combination clindamycin 1.0%–1.2%-tretinoin 0.025% gel (CTG) to monotherapy with clindamycin, tretinoin, or vehicle.¹³ n = sample size of study population.
Study (12 weeks)	Comparative Treatments	Study Design	Major Results	Adverse Effects
Leyden et al.⁹ n=2219	CTG vs. monotherapy with clindamycin, tretinoin or vehicle	Two randomized, doubleblind, multicenter, active drug- and vehiclecontrolled	CTG group showed superior efficacy in treating inflammatory and noninflammatory lesions compared with monotherapy or vehicle alone	Well tolerated overall; 87.6% of participants reported no adverse events
Yentzer et al.¹⁰ n=21	CTG vs. application of two separate generic subcomponents	Single-blind, prospective, single center, randomized, controlled	CTG group showed a significant reduction in total lesions over length of study; both groups experienced improvement in mild to moderate acne	Treatment was well tolerated in both groups
Richter et al.¹¹ n=152	CTG vs. 0.025% tretinoin gel	Randomized, doubleblind, multicenter	CTG was superior to tretinoin in papular and inflammatory lesions and in overall acne severity	Less burning reported with CTG
Zouboulis et al.¹² n=206	CTG vs. clindamycin lotion	Multicenter, single-blind, randomized, comparative	CTG was more effective at reducing acne lesions than clindamycin monotherapy	More erythema and desquamation reported with CTG

Table 2. Studies comparing adapalene-BPO combination therapy to monotherapy with adapalene, BPO, and vehicle.¹³
Study (12 weeks)	Comparative Treatments	Study Design	Major Results	Adverse Effects
Gollnick et al.¹⁷ n=1670	Adapalene-BPO vs. monotherapy of either drug alone and gel vehicle	Randomized, doubleblind, controlled	Adapalene-BPO showed significantly greater efficacy than monotherapies	Well-tolerated, with comparable tolerability to adapalene monotherapy
Gold et al.¹⁸ n=1429	Adapalene-BPO vs. monotherapy of either drug alone and gel vehicle	Multicenter, randomized, double-blind, parallelgroup, active- and vehicle-controlled	Adapalene-BPO showed higher success rate and reduction of acne lesions than other groups	Comparable safety of adapalene-BPO to monotherapies and gel vehicle
Thiboutot et al.¹⁹ n=517	Adapalene-BPO vs. monotherapy of either drug alone and gel vehicle	Randomized, doubleblind, controlled	Adapalene-BPO was considerably more effective than monotherapies; significant reduction in lesion counts at 1 week	Similar adverse event frequency and tolerability profile for combination gel vs. adapalene monotherapy
Poulin et al.²⁰ n=243	Adapalene-BPO vs. vehicle	Multicenter, randomized, double-blind, controlled	Significantly higher lesion maintenance success rate for inflammatory and noninflammatory lesions with adapalene-BPO	Adapalene-BPO was safe and well-tolerated

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