Maintenance Therapy for Acne Vulgaris: Efficacy of a 12-Month Treatment with Adapalene-Benzoyl Peroxide after Oral Isotretinoin and a Review of the Literature

Abstract

Background: The correct therapeutic management of acne should include a maintenance therapy with topical retinoids to prevent recurrences after discontinuing a successful treatment. Objective: To investigate the efficacy of a 12-month maintenance treatment with adapalene 0.1% and benzoyl peroxide (BPO) 2.5% fixed combination gel to control acne relapse after treatment with oral isotretinoin (OI). Methods: The study consisted of 2 phases, namely an active treatment phase (AP) and a maintenance phase (MP). In the AP, 70 consecutive patients with moderate to severe acne were treated with OI until acne remission. Then, patients entered the MP and were treated with adapalene-BPO fixed combination once daily for 12 months. The primary efficacy parameter was the relapse rate during MP. Results: Sixty-eight patients completed the study. Relapse occurred in 2 patients (2.94%). Conclusions: Comparing our findings with published data, the association of a topical retinoid and BPO seems to provide favorable evidence for this combination as maintenance therapy.

Assessment of the Efficacy and Safety of a Combination of 2 Topical Retinoids (RetinSphere) in Maintaining Post-Treatment Response of Acne to Oral Isotretinoin

“…3,11,12 Likewise, this study confirms that maintenance therapy with retinoids after discontinuation of oral isotretinoin with residual acne lesions can reduce both non-inflammatory and inflammatory lesions. To prevent such relapses, this new retinoid combination has proven effective and is able to significantly improve acne lesions compared with baseline and with treatment with vehicle.…”

How Much Do We Know about Maintaining Treatment Response after Successful Acne Therapy? Systematic Review on the Efficacy and Safety of Acne Maintenance Therapy

“…These studies had recruited 261 participants. In 2013, Bettoli et al [12] reported maintenance baseline data (mean age 21.2 years, range 13-38, 47.83% women, n = 70). In 2011, Gollnick et al [13] conducted a study with just men, and in 1983 Meigel et al [14] provided no sociodemographics.…”

“…Bettoli et al [12] conducted a non-randomized intervention study treating 69 responders (defined as complete clearance after treatment with oral isotretinoin ≤0.2 mg/kg; duration specified as ‘until clear') with adapalene 0.1%/BPO 2.5% fixed combination q.d. The only reported outcome was relapse defined as the re-occurrence of acne severity grade ≥0.5 (10 papules and pustules and 10 comedones), which was only experienced by 2 patients.…”

“…In all three studies the risk of baseline confounder and the risk of selective reporting were serious due to some missing baseline [14] or outcome data [12], or unknowable modification of inclusion criteria [13]. …”

Synchronizing pharmacotherapy in acne with review of clinical care

“…[30] The relapses in severe and moderate to severe acne patients can be prevented with the use of adapalene-BPO combination as maintenance therapy (for 6–12 months) subsequent to treatment with oral isotretinoin. [3738] Combination of BPO with other retinoids is found to be unstable and hence avoided [Table 4]. [29]…”