For patients with severe inflammatory acne (non-nodulocystic/non-conglobate), treatment with adapalene and benzoyl peroxide gel 0.3%/2.5% (Epiduo Forte Gel; Galderma) plus oral doxycycline 100mg twice daily appears to be a safe and effective option, according to findings from the Phase 4 ALAMO study.

The ALAMO study was an open-label, single-arm, multicenter, investigational study that enrolled 186 patients aged ≥12 years with severe inflammatory acne who were considered candidates for oral isotretinoin (OI) therapy. The primary efficacy endpoint was the reduction in number of inflammatory lesions at the end of the 12-week period. 

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Treatment with the combination gel + oral doxycycline was associated with a 66.2% reduction in inflammatory lesions, a 58.7% reduction in non-inflammatory lesions, and a 62.6% reduction in total lesions at Week 12 vs baseline (P <.0001). Moreover, 37.1% of patients achieved Investigator’s Global Assessment (IGA) success (defined as IGA 0 [clear] or 1 [almost clear])(P <.0001). 

At the end of the treatment period, 80.1% of patients were no longer considered candidates for OI. Most of the study patients (90.2%) reported at least moderate improvement in acne vulgaris (AV) (90.2%); 83.2% said they were “satisifed” or “very satisfied” with the combination treatment overall. Skin burning sensation and erythema were the most common treatment-emergent adverse events (AEs) reported. 

“[Adapalene/benzoyl peroxide gel 0.3%/2.5% plus doxycycline] is an effective and safe treatment option for severe inflammatory AV, before starting OI treatment, or as an alternative when OI cannot be used,” the authors concluded.

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