What is new ?

"Combination therapy including agents of distinct and complementary modes of action may enhance treatment efficacy and is recommended in several international consensus guidelines," comment Brigitte Dréno (Hôpital Hotel Dieu, Nantes, France) and colleagues in the British Journal of Dermatology.
Recent study findings showed that combination treatment with the second generation tetracycline, doxycycline plus A/BPO was superior to doxycycline and vehicle for severe acne vulgaris.
However, doxycycline is moderately phototoxic and has been known to induce hyperpigmentation. In the current study, the researchers, investigated another tetracycline, lymecycline, which is not thought to cause such side-effects.
In all, 378 subjects were randomly assigned to receive once-daily lymecycline (300 mg) with either A/BPO (0.1%; 2.5%) or vehicle, for 12 weeks.
Patient assessment included percentage changes from baseline in lesion counts, success rate ( "clear" or "almost clear" skin), skin tolerability, adverse events, and patient satisfaction.
Both groups showed a significant reduction in inflammatory and noninflammatory lesions at week 12, although patients taking the combination therapy displayed a rapid onset of action from week 2 for noninflammatory lesions and week 4 for inflammatory lesions.
Indeed, patients in the combination group showed a significantly greater reduction in total lesion count at 12 weeks than those in the vehicle group, at 74.1% versus 56.8%.
Furthermore, the success rate was significantly higher in the combination than vehicle group, at 47.6% versus 33.7%. The A/BPO and lymecycline combination was also well-tolerated.
The total number of satisfied/very satisfied patients was similar in both groups, but the number in the combination group who were very satisfied was significantly greater than in the lymecyline plus vehicle group.
The researchers note that noticeable improvement and patient satisfaction are particularly important outcomes since they have been shown to be independently correlated with poor treatment adherence behaviour in a large-scale observational study.
Dréno et al conclude: "Though there are limits to applying results of a randomized controlled trial to the general population as they may differ from those in practice, our large sample size including both moderate and severe acne patients can presumably indicate pertinence of our results for patients in the clinical setting."