(HealthDay News) — Oral doxycycline plus adapalene/benzoyl peroxide (D+A/BPO) gel is an effective alternative to oral isotretinoin (ISO) for the treatment of severe nodular acne, according to a study published in the December issue of the British Journal of Dermatology.

Jerry Tan, MD, from the University of Western Ontario in Windsor, Canada, and colleagues conducted a randomized, 20-week trial to compare the efficacy and safety of oral ISO and doxycycline 200mg plus adapalene 0.1%/benzoyl peroxide 2.5% gel in the treatment of severe nodular acne.

The researchers found that D+A/BPO showed a significantly earlier onset of action in reducing nodules, papules/pustules, and total lesions at week two. By 20 weeks, ISO was superior in reducing nodules, papules/pustules, and total lesions (all P<0.01). Compared with ISO, half as many D+A/BPO subjects had treatment-related, medically relevant adverse events (33 events in 18.0% of subjects vs. 73 in 33.8% of subjects). Based on the composite efficacy/safety end point, D+A/BPO was noninferior to ISO in the intent-to-treat population (P=0.13; 63.9 and 54.9% of subjects, respectively) and per-protocol population (P=0.01; 74.3 and 58% of subjects, respectively).

“This combination is an alternative to ISO in patients intolerant to, or unable or unwilling to take, oral ISO, and is an option for treatment of severe nodular acne,” the authors write.

Several authors disclosed financial ties to Galderma, which funded the study and manufactures Epiduo, an adapalene 0.1%/benzoyl peroxide 2.5% gel.

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