New therapeutic options add value to current acne treatment

Novel topical and systemic therapies from different drug classes broaden the current acne armamentarium.

“Clascoterone is an exciting new topical anti-androgen for both men and women with acne,” said Dr John Barbieri (Perelman School of Medicine, University of Pennsylvania, USA) [1]. The agent competes with androgens for binding to the androgen receptor, leading to blockade of the vicious circle of sebum production and pro-inflammatory cytokine release. Contrary to other anti-androgens, it is rapidly metabolised to cortexolone and has almost no systemic effect. Phase 3 trials support safety and efficacy of clascoterone: therapy with clascoterone cream led to a 20% success according to Global Investigator’s Assessment (IGA) versus ~8% with the vehicle [2]. Inflammatory papules and pustules decreased by 45%. “There were only minimal side effects, so this is a great medication for patients with sensitive skin,” Dr Barbieri concluded. “In addition, this is one of the first anti-androgens we can use in our male patients,” Barbieri elaborated.

New topical retinoids and formulations may have better efficacy and tolerability, but additional comparative effectiveness data is needed. Another progress in acne therapy is the FDA approval of the fourth-generation retinoid trifarotene, which is a highly selective agonist for the retinoid acid receptor gamma. In 2 randomised phase 3 trials, trifarotene cream (50 µg/g) showed a similar efficacy profile to other retinoids, with an IGA success rate in the face of 29.3%; it was also effective in trunk acne [3]. Moderate erythema was present in 25% of patients and severe in 5%; the same percentages were observed for scaling. Dry skin was present in 30% of patients. “Future studies should assess how trifarotene compares with standard-of-care topical retinoids, but it is unique in its selectivity, and we can use it in children aged ≥9 years,” said Dr Barbieri.

“Another interesting idea is to improve the tolerability by changing the vehicle,” Dr Barbieri continued. In a phase 2 trial, tazarotene lotion caused side effects in only 14.7% versus 26.8% in patients treated with tazarotene cream; the efficacy was similar [4].

Minocycline foam (4%) is another interesting new topical antibiotic for acne. It was effective and well tolerated in 2 double-blind phase 3 trials compared with vehicle foam [5]. Again, Dr Barbieri emphasised that future studies are needed to assess how the foam compares with standard-of-care topical antibiotics.

Sarecycline is a narrow-spectrum tetracycline designed for acne which may have and improved side-effect profile and reduced risks of microbiome alterations and resistance than other tetracyclines. It is very active against Cutibacterium acnes but shows less activity against other bacteria, in particular gram-negative bacteria. Therefore, it causes less changes in microbiome, which might result in a lower risk of gastrointestinal side effects. In a phase 3 trial, it led to IGA success in about 20% of patients with good tolerability. The most common adverse event was nausea, occurring in about 2.5% of patients [6].

1. Barbieri J, Novel topical and systemic acne treatments: are they adding value? Session F002, AAD VMX 2021, 23-25 April.
2. Hebert A, et al. JAMA Dermatol 2020;156(6):621-30.
3. Tan J, et al. J Am Acad Dermatol 2019;80(6):1691-9.
4. Tanghetti EA, et al. J Drugs Dermatol 2020;19(1):70-7.
5. Stein Gold L, et al. J Am Acad Dermatol 2019;80(1):168-77.
6. Moore A, et al. J Drugs Dermatol 2018;17(9):987-96.

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Posted on 7 June, 20217 June, 2021