Мета-анализ подтвердил эффективность топического ивермектина при розацеа

Topical ivermectin, encapsulated benzoyl peroxide most effective for rosacea Key takeaways: - Data show topical ivermectin is the best first-line option for adults with moderate to severe rosacea. - Encapsulated benzoyl peroxide, while effective, was associated with adverse events including itch and pain. Topical ivermectin and encapsulated benzoyl peroxide appear to be the most effective FDA-approved topical treatments for papules and pustules of rosacea when compared with standard first-line therapy, according to a new meta-analysis. The analysis of nearly three dozen studies with more than 11,000 participants, published in JAMA Dermatology, also showed encapsulated benzoyl peroxide, which uses microencapsulation technology to prolong drug delivery and minimize irritation, was associated with greater rates of discontinuation due to adverse effects. These findings suggest the topical ivermectin might be a more suitable choice for long-term maintenance therapy. “Both treatments were associated with greater reductions in inflammatory lesion counts and higher rates of achieving clear or almost clear skin compared with metronidazole and other options,” John Barbieri, MD, MBA, a Healio Dermatology Peer Perspective Board Member and associate professor at Harvard Medical School, said in an email interview. “However, encapsulated benzoyl peroxide was also associated with higher rates of discontinuation due to side events. As a result, topical ivermectin may be a better first-line option.” Barbieri and colleagues analyzed data from 32 randomized controlled trials with 11,399 adult participants (mean age across trials, 49.4 years) who had moderate to severe rosacea. Participants were treated with a range of 10 FDA-approved topical interventions that included: - metronidazole; - ivermectin; - azelaic acid; - minocycline; - encapsulated benzoyl peroxide; - brimonidine; - oxymetazoline; and - sulfacetamide. The primary outcomes were mean change in absolute lesion count, Investigator Global Assessment (IGA) success and treatment discontinuation due to tolerability concerns. Researchers also assessed various quality of life metrics and changes in rosacea facial redness. For lesion count, data showed topical ivermectin was associated with a greater reduction compared with metronidazole (mean difference, 4.17 lesions; 95% CI, 1.85-6.48), followed by encapsulated benzoyl peroxide (mean difference, 4.14 lesions; 95% CI, 0.62-7.66). Researchers did not observe between-group differences in lesion count for participants treated with minocycline vs. metronidazole. Encapsulated benzoyl peroxide and ivermectin were also associated with a greater likelihood of achieving IGA success when compared with metronidazole, with mean differences of 15.51 percentage points (95% CI, 2.35-28.68) and 10.31 percentage points (95% CI, 2.85-17.77), respectively. The researchers, while calling the encapsulated benzoyl peroxide findings “noteworthy,” also wrote that some participants who received it reported more adverse event-related discontinuation compared with first-line treatment (mean difference, 8.33; 95% CI, 0.45-16.22), driven by reports of pain, erythema, pruritus and edema. “These findings suggest that encapsulated benzoyl peroxide can be a highly effective option, particularly for those who may have had an inadequate response to other treatments,” Barbieri said. “It is an optimized vehicle to enhance tolerability, so it can be considered even in those who have issues with benzoyl peroxide products in the past. Notably, in the pivotal clinical trials, absolute rates of discontinuation due to side effects were only about 3%. However, it can be irritating and may not be the best option for those with extremely sensitive skin. When using it, combining it with good skin care, including sun protection and moisturizer use, is important to maximize tolerability.” Most rosacea trials are about 3 to 4 months in duration, and more data are needed on long-term outcomes, Barbieri said, including the durability of response and how best to approach maintenance therapy once clear skin is achieved. “Although our network meta-analysis provides some insights into the relative efficacy and tolerability of these treatments, it is not a substitute for head-to-head trials, which are needed to better understand how these options compare,” Barbieri told Healio. “We also need more data on treatments for redness and how they compare with each other. Finally, few trials included patient-reported outcomes, which is a gap with respect to capturing patient-centered outcomes.” For more information: John Barbieri, MD, MBA, is a Healio Dermatology Peer Perspective Board Member, associate professor at Harvard Medical School and director of the Advanced Acne Therapeutics Clinic at Brigham and Women’s Hospital. Barbieri can be reached at [email protected]; YouTube @DrJohnBarbieri; LinkedIn John Barbieri, MD, MBA.