Rosacea; Combining ivermectin cream (IVM) and doxycycline modified-release capsules (DMR) can improve response rates for patients with severe rosacea, according to a study recently published in the Journal of the American Academy of Dermatology. Martin Schaller, M.D., from Tubingen University Hospital in Germany, and colleagues conduct a 12 week multicenter, randomize comparative trial involving adults with severe rosacea.
Rosacea is a chronic inflammatory disease of the skin that displays a broad diversity of clinical manifestations; so from erythema to inflammatory lesions and phymata, as well as ocular symptoms. Combination therapy with topical and oral agents has become a common treatment option; so for patients with moderate and severe rosacea presenting with diverse signs and symptoms. By simultaneously treating different rosacea features; so combination therapy might be preferable to monotherapies.
Moderate and severe rosacea
A total of 273 participants were randomly assign to IVM and DMR (combination arm) and IVM and placebo (monotherapy). The researchers found that IVM and DMR exhibit superior efficacy in reducing inflammatory lesions; so compare with monotherapy and in the Investigator’s Global Assessment (IGA) score.
As of week 4, combination therapy had a faster onset of action; at week 12, significantly more patients achieve IGA 0 (11.9 versus 5.1%; P = and 100% lesion reduction with combination therapy. The Clinician’s Erythema Assessment score, stinging/burning, flushing episodes, Dermatology Life Quality Index; also ocular signs/symptoms were reduce with both treatments, and both treatments were well-tolerated.
Combination therapy studies in rosacea are limited; so with high-level evidence lacking regarding the superiority of a combination therapy approach. The topical agents evaluate in previous combination therapy studies are metronidazole and azelaic acid; primarily with oral doxycycline. Concomitant use of ivermectin 1% cream (IVM) and brimonidine 0.33% gel demonstrate superior efficacy regarding erythema and inflammatory lesions.
Combination of metronidazole
Another study found a combination of metronidazole 1% gel and doxycycline 40 mg modified-release capsules (DMR) demonstrate greater mean reduction in inflammatory lesion counts from baseline to week 12 versus metronidazole 1% gel (MetroGel® gel; Galderma Production Inc, Quebec, Canada) alone. Additionally, IVM once daily show superiority to metronidazole 0.75% cream twice daily; so in terms of percentage reduction of inflammatory lesion counts and quality-of-life improvement.
“These study results suggest that using a combination of IVM and DMR, each once daily, along with a properly select skin care regimen, can improve treatment results,” the authors write. “Ultimately, overall patient satisfaction was achieve more frequently in those subjects who utilize the combination therapy.” Several authors disclose ties to pharmaceutical companies, including Galderma; which fund the study and provide the study product.
In conclusion, these study results suggest that using a combination of IVM and DMR, each once daily, along with a properly select skin care regimen, can improve treatment results. Faster onset of visible improvement, greater efficacy, a reduction in flushing episodes, and a decrease in facial stinging and burning were all observed, offering the opportunity to reach skin clearance in more patients, while not compromising safety. Ultimately, overall patient satisfaction was achieve more frequently in those subjects who utilize the combination therapy.