Evidence for the efficacy of topical retinoids was available from two systematic reviews,14,24 which examined 20 RCTs and split-face studies.25-43 Two further studies were located through searching4445 (See Web Table 13.1). Focusing
Figure 13.2 Non-inflammatory lesions. By kind permission of Dr Carolyn Charman.
only on comparisons that had at least two RCTs of acceptable quality showing moderate-to-strong statistical evidence, the authors of the AHRQ review concluded that 0-1% adapalene and 0-025% tretinoin were equally efficacious and that motretinide and tretinoin were equally effective. The second review24 evaluated five RCTs of 0-1% adapalene gel versus 0-025% tretinoin.29-31,34,46 All RCTs were investigator blind and a total of 900 individuals with mild-to-moderate acne were enrolled. Using data collected from intention-to-treat (ITT) analyses, equivalent efficacy against total lesion counts was demonstrated, with adapalene showing greater activity at 1 week.
Further examination of the results show that of the six RCTs that presented data,29,30 33 34 46 mean percentage reductions in NIL ranged from 46% to 83% in the 0-1% adapalene group and from 33% to 83% in the 0-025% tretinoin group at 12 weeks. Percentage reductions in IL were 48-69% and 38-71%, respectively. Higher-strength adapalene (0-5%) was investigated in one 25-patient split-face study and was shown to have greater activity than 0-1% adapalene against both IL and NIL, but was associated with more erythema.45 Two strengths of adapalene (0-1% and 0-03%) were evaluated in three studies
What is the role of topical non-antibiotic agents in the treatment of mild primarily noninflammatory acne?
enrolling a total of 186 patients with mild-to-severe acne.28,29,47 The higher strength produced greater reductions in IL and NIL counts but was associated with more irritation.
Little comparative data for retinoids against other agents were retrieved. In 77 patients with mild-to-moderate acne, 0-05% isotretinoin applied twice daily was slightly less effective than 5% benzoyl peroxide against IL and NIL and was slower to resolve IL.42 The results for tretinoin against benzoyl peroxide48-50 were equivocal and there were no differences in the rate of adverse events.
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