Abstract
BackgroundRosacea is a common chronic skin condition that manifests as recurrent inflammatory lesions. Long-term treatment is required to control symptoms and disease progression, with topical treatments being the first-line choice. Ivermectin 1 % cream is a new once-daily (QD) topical treatment for the inflammatory lesions of rosacea, and it is important to compare the efficacy, safety, and tolerability of ivermectin with other currently available topical treatments.MethodsA systematic literature review was performed from January 2011 to June 2015, with articles published prior to 2011 retrieved from a Cochrane review on rosacea. Randomized controlled trials of the topical treatment of adult patients with moderate-to-severe papulopustular rosacea were identified from electronic databases and trial registers, and supplemented with data from clinical study reports. Mixed treatment comparisons (MTCs) were conducted to compare different treatments according to Bayesian methodology.Results57 studies were identified, with 19 providing data suitable for MTC. Ivermectin 1 % cream QD led to a significantly greater likelihood of success compared with azelaic acid 15 % gel twice-daily (BID) [relative risk (95 % credible interval): 1.25 (1.14–1.37)], and metronidazole 0.75 % cream BID [1.17 (1.08–1.29)] at 12 weeks. Ivermectin 1 % cream QD also demonstrated a significant reduction in inflammatory lesion count compared with azelaic acid 15 % gel BID [−8.04 (−12.69 to −3.43)] and metronidazole 0.75 % cream BID [−9.92 (−13.58 to −6.35)] at 12 weeks. Ivermectin 1 % cream QD led to a significantly lower risk of developing any AE or TRAE compared with azelaic acid 15 % gel BID [0.83 (0.71–0.97) and 0.47 (0.32–0.67), respectively].ConclusionsIvermectin 1 % cream QD appears to be a more effective topical treatment than other current options for the inflammatory lesions of rosacea, with at least an equivalent safety and tolerability profile, and could provide physicians and dermatologists with an alternative first-line treatment option.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-2819-8) contains supplementary material, which is available to authorized users.
Highlights
Rosacea is a common chronic skin condition that manifests as recurrent inflammatory lesions
Topical treatments are the first-line choice for patients due to a lower risk of adverse events (AEs), drug interactions, and antibiotic resistance compared with systemic therapy (Goldgar et al 2009)
Four clinical study report (CSR) were provided by Galderma, giving a total of 55 studies included for extraction
Summary
Rosacea is a common chronic skin condition that manifests as recurrent inflammatory lesions. Papulopustular rosacea is a common chronic skin disease that affects the central facial area, primarily manifesting as recurrent inflammatory episodes of papules and/. There is no increase in mortality with rosacea, the chronic nature of the disease and expression of symptoms in the facial region may lead to stigmatization. As a result, it is associated with a significant adverse impact on quality of life (QoL) (Goldgar et al 2009; Aksoy et al 2010; Wolf and Del Rosso 2007) and may lead to depression or social anxiety disorder (Bohm et al 2014). With the introduction of new therapies such as ivermectin 1 % cream QD, it is important to understand which treatment can provide patients with the greatest clinical benefit
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