Rosacea Treatment with Topical Ivermectin

Comparative Efficacy and Safety of Ivermectin Cream 1% and Metronidazole 0.75% in the treatment of papulopustular Rosacea

Taieb A. et al

AAD 2015 Annual Meeting, San Francisco CA – United States

Methods

• 962 subjects enrolled
• evaluation of recurrence 36 weeks after
• study done over 16 weeks
• Evaluation of Rosacea severity in both treated groups (metronidazole 0.75% vs ivermectin 1%)
  • Investigator Global Assessment (IGA): moderate to severe papulopustular Rosacea
  • 15 to 70 facial papulopustular lesions (papules and pustules)
  • 32 inflammatory lesions on average
  • moderate rosacea (IGA of 3)
• Evaluation of results:
  • blinded assessments at weeks 3, 6, 9, 12, 16:
  • IGA
  • inflammatory lesion counts
  • adverse effects
  • patient self-evaluation and questionnaire at week 16

Results

• Efficacy
  • Statistically significant reduction of:
    • inflammatory lesions (83% (Ivermectin) vs 73.3% (metronidazole) seen from week 12
    • IGA of clear or almost clear (84.9% vs 75.4% of cases)
    • patients reported excellent or good compared (85.5% vs 74.8%)
    • 34.9% of patients on ivermectin were completely clear (vs 21.7% with metronidazole)
• Safety:
  • Adverse Events 32.4% for vs 33.1% (metronidazole)
  • Related Adverse Events (2.3% vs 3.7%) (for related dermatological Adverse Events 1.9% vs 2.5%)
• Tolerability:
  • stinging/burning (15.5% vs 11.1%)
  • dryness (12.8% vs 10%
  • itching (11.4% vs 8.8%)

Comments

• Ivermectin is available as a topical cream called Soolantra in the United States
• For the results:
  • Although mentioned in the methods, the data concerning the recurrence was not published
  • It might have been interesting to compare the efficacy with two other topicals used in the treatment of Rosacea: Brimonidine and Azelaic Acid
  • There appears to be around 10% superior improvement rate with ivermectin compared with metronidazole.
  • Also, the clearance rate is around a third of cases in ivemectin group  vs a fifth in the metronidazole group
• For the safety:
  • there is no mention of what the Adverse Events or Related Adverse events are
  • there is no mention of the results being statistically different in Ivermectin vs Metronidazole
  • Although written as a take home message, no conclusions can be made concerning safety (compared with metronidazole): although a small difference seems to appear, it has no statistically significant power
• For Acne, studies have compared oral treatments with oral treatments. It is interesting to note that this has NOT been done for Rosacea.

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland