Taro Pharmaceuticals in fact already markets a generic form of Metrogel – Metronidazole Gel USP, 0.75%

When the patent covering Metrogel 0.75% expired, Galderma changed the formulation, increased the concentration of metronidazole to 1% and now produces the best-known rosacea treatment, Metrogel 1%.

This is good news for rosacea suffers, who can only benefit from competition in the rosacea treatment staples market. Often rosacea sufferers come away from their first visit to the doctor and pharmacist with one thought – Why is this Metrogel so expensive?

Trial CT01513863 is listed to compare Taro Pharmaceutical’s Generic Metronidazole 1% Gel with Galderma’s Metrogel 1% (and also placebo).

Clinical Trial NCT01513863

A Therapeutic Equivalence Study of Two Metronidazole 1%Topical Gel Treatments for Patients With Rosacea (MTZG)

A Randomized, Double-Blind, Placebo Controlled, Parallel Design, Multi-Site Clinical Study to Compare the Bioequivalence of Two Metronidazole 1% Topical Gel Formulations in Patients With Moderate to Severe Rosacea

Arm 1

Metronidazole Topical Gel 1%: Experimental

Intervention: Drug: Metronidazole Topical Gel 1%

Arm 2

Metronidazole Topical Gel 1% (Metrogel ): Active Comparator

Intervention: Drug: Metronidazole Topical Gel 1% (Metrogel)

Arm 3

Placebo: Placebo Comparator

Intervention: Drug: Placebo

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• Metronidazole (Metrogel, Flagyl) is a popular rosacea treatment

Galderma have announced that Metrogel 1% will now be available in a 55gm Pump. Galderma are citing the benefits of a better looking dispenser, minimizing waste, easier compliance with prescribing instructions and “facilitating product handling”. Galderma received FDA approval for Metrogel 1% Pump in October 2011.

Metrogel 1% Pump is now available on prescription in pharmacies across the U.S.

As we know, the Metronidazole market is awash with choices; Metrogel 1%, Rozex, Metrolotion, Metrocream and Noritate – and now Metrogel 1% Pump.

Galderma Announces Availability of New Metrogel(R) 1% Pump Dispenser for the Treatment of Papulopustular Rosacea

Pump Delivery Provides Consistent Dosing, Minimizes Waste and May Help Increase Patient Compliance

FORT WORTH, TX–(Marketwire -01/17/12)- Galderma Laboratories, L.P. today announced the availability of a new pump dispenser design for MetroGel® (metronidazole) Gel, 1%, the most powerful strength of topical metronidazole available in a gel to treat the inflammatory lesions (bumps and blemishes) associated with rosacea. The MetroGel® 1% Pump, which the U.S. Food and Drug Administration approved in October 2011, is now available by prescription to patients in pharmacies nationwide.

Results from a new survey of 207 physician-diagnosed rosacea patients, ages 25 to 65, found 69 percent of patients prefer a pump over a tube. Patients in the survey also felt the pump was more aesthetically pleasing and reported the pump delivery facilitates product handling and storage and minimizes waste. Additionally, patients thought the pump delivery would help them to follow their doctor’s instructions on product usage.

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Galderma has another rosacea-targeted treatment, until now undisclosed, in the final stages of approval. Hey – how come no one told me?

Could it be possible that the rosacea heavyweight Galderma has kept a new product so secret?

What is this CD5024?

Just what exactly is this CD5024 1% Cream? Galderma always give code names to their in-development products, why has no one noticed this new code so far?

I can’t find many clues, but my guess is that CD5024 is a 1% cream formulation of metronidazole.

Read on to see why my guess is that we can pretty much ignore CD5024 as being something new and innovative.

Two Clinical Trials Posted

I was first alerted to the new product CD5024 when two new clinical trials were posted at clinicaltrials.gov. Both of these are Phase 3 Trials, suggesting that the product was in the latter stages of product development.

• Trial NCT01493947 is a Phase 3 trial comparing CD5024 to Metronidazole 0.75% for 16+36 weeks.
• Trial NCT01493687 is a Phase 3 trial proving CD5024 works better than placebo after 12 weeks, for the papules and pustules of rosacea. A further 40 weeks to prove that CD5024 is as safe as Finacea.

So it seems a reasonable guess that as the trials want to compare against Finacea, the concentration is 1% and the target is the papules and pustules of rosacea, that CD5024 is merely metronidazole.

Another reference to CD5024 was from 2006 in an Australian trial. Perhaps this is another hint – Metronidazole in a 1% formulation is not available in Australia, so perhaps this shows that Galderma is preparing a Metrocream 1% for a wide market.

Do We Need Another Metro Sibling?

If I am correct, and CD5024 is merely MetroCream 1%, it will be joining a pretty crowded metronidazole market. Even though you can find Metrogel 1%, Metrogel 0.75%, Metrocream, Metrolotion, Noritate and even Metronidazole with sunscreen, some research suggests that it doesn’t actually matter which you choose, they all work much same. Marketing gone mad? I would suggest so.

Your Thoughts

Do you have any more information about CD5024? Please let us know in the comments below or drop me an email to david AT rosacea-support.org. Thanks.

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Galderma has a long history with topical metronidazole products, starting with Metrogel 0.75%, then adding Metrolotion and Metrocream, and when the patent on the 0.7% Metrogel expired, Galderma created Metrogel 1%.

Past research seems to suggest that it matters little whether you use Metrogel, Metrolotion, Metrocream or Noritate. Further it seems to not matter whether you use these products once or twice per day.

As far as foam based rosacea treatments are concerned, we learnt in 2009 that a clinical trial would investigate whether a foam based form of Finacea was safe and effective.

The foam being patented is described as a “stable, metronidazole-based oil-in-water emulsion expandable into a topically applicable foam having a firm, creamy and light consistency” and is claimed to have improved release-penetration capacity.

METRONIDAZOLE-BASED DERMATOLOGICAL FOAM AND EMULSIONS FOR THE PRODUCTION THEREOF

Oil-in-water emulsions expandable into stable foams having diminished inhibitor of skin breathing and useful for the treatment of dermatological conditions/afflictions, e.g., rosacea, advantageously contain:

(a) 72% to 76% of water;
(b) 0.1% to 5% of a gelling agent for the aqueous phase of the emulsion;
(c) 0.75% to 2% of metronidazole;
(d) 5% to 10% of mineral oil;
(e) 0.5% to 10% of a surfactant;
(f) 0.5% to 5% of a fatty acid;
(g) 0% to 4% of a metronidazole absorption promoter (c); and
(h) 0.1% to 5% of a preservative selected from the group consisting of methylparaben, propylparaben, phenoxyethanol and mixtures thereof.

Domain Name

Galderma have owned the domain name metrofoam.com since 2004, which currently just redirects to Galderma.com.

Can You Get Excited?

Does the thought of being able to get your Metronidazole dose from a foam do anything for you?

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This review looked at the published results of 58 trials to note bias and construct a high level summary of the results.

No Surprises Here

It will come as little surprise that the well known treatments Metrogel, Finacea and Oracea were found to be effective. These prescription based treatments from Galderma and Intendis have seen high levels of investment in research and development and indeed marketing specifically as rosacea treatments.

What is a Cochrane Review

From The Cochrane Collaboration: Cochrane Reviews are designed to facilitate the choices that doctors, patients, policy makers and others face in health care. Most Cochrane Reviews are based on randomized controlled trials, but other types of evidence may also be taken into account, if appropriate.

What Bias?

The Cochrane Review attempts to identify any bias that may have affected the outcome of the trials reviewed.

Many levels of bias are possible; are the participants truly randomly selected, representative of the population, truly blinded to the treatments?, are outcomes fairly reported? what about exclusions and attrition rates ?

Any one of these sorts of bias can cause the results of a trial to be questioned. As is the usual case with these large systematic reviews, high or unclear levels of bias were present in the clinical trials.

Clinical Trials without any bias are hard to achieve and seem to be quite rare.

Effective and evidence-based management strategies for rosacea: summary of a Cochrane systematic review, Br J Dermatol. 2011 Jun 21, van Zuuren EJ, Kramer SF, Carter BR, Graber MA, Fedorowicz Z.

Background: Rosacea is a common chronic skin disease affecting the face. There are numerous treatment options, but it is unclear which are the most effective.

Objective: To assess the evidence for the efficacy and safety of treatments for rosacea.

Methods: Searches included the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers (updated February 2011). Randomized controlled trials in people with moderate to severe rosacea were included.

Results: Fifty-eight trials, including 27 from the original review, comprising 6,633 participants were included in this updated review. Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others. There was some evidence that topical metronidazole and azelaic acid were more effective than placebo. Two trials indicated that doxycycline 40 mg was more effective than placebo. There was no statistically significant difference in effectiveness between doxycycline 40 mg and 100 mg and with evidence of less adverse effects. One study reported that cyclosporine ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea.

Conclusions: Although the majority of included studies were assessed as being at high or unclear risk of bias, there was some evidence to support the effectiveness of topical metronidazole, azelaic acid, and doxycycline (40 mg) in the treatment of moderate to severe rosacea, and cyclosporine 0.05% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately-powered randomised controlled trials are required.

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Recent research is highlighting just how important are all of the ingredients in a topical preparation.

The benefits to your skin from the vehicle components help explain why one might even obtain relief from vehicle-only preparations. For example if you are on a clinical trial that is blinded. Particularly if your skincare regime is not supporting the functions of your skin, the vehicle carrying the active ingredient in a topical may itself be worth using.

This further reinforces the argument that a gentle (and supportive) skincare regime is important for rosacea sufferers.

Of course mixing your own topicals is not an easy task, so mostly we are limited to the formulations that have been made for us by the pharmaceutical companies.

As a refresher here is a listing of ingredients of the most popular rosacea topicals. As you can see it is not an easy task to discover just from the listing whether a topical is going to be a winner for you.

Metrogel Ingredients

METROGEL (metronidazole gel), 1% is an aqueous gel; each gram contains 10 mg of metronidazole in a base of betadex, edetate disodium, hydroxyethyl cellulose, methylparaben, niacinamide, phenoxyethanol, propylene glycol,propylparaben and purified water.

Finacea Ingredients

Each gram of Finacea contains 0.15g (15%) micronized azelaic acid in a gel base. It also contains 0.1% benzoic acid, propylene glycol, polysorbate 80, lecithin, polyacrylic acid, triglycerides (medium chain), sodium hydroxide, disodium edetate and purified water.

Plexion Ingredients

Each gram of Plexion® (sodium sulfacetamide USP 10% and sulfur USP 5%) Topical Suspension contains 100 mg of Sodium Sulfacetamide USP and 50 mg of Sulfur USP in a suspension containing: Purified Water USP, Propylene Glycol USP, Isopropyl Myristate NF, Light Mineral Oil NF, Polysorbate 60, Sorbitan Monostearate NF, Cetyl Alcohol NF, Hydrogenated Coco-Glycerides, Stearyl Alcohol NF, Fragrances, Benzyl Alcohol NF, Glyceryl Stearate (and) PEG-100 Stearate, Dimethicone NF, Zinc Ricinoleate, Xanthan Gum NF, Edetate Disodium USP, and Sodium Thiosulfate USP.

Klaron Ingredients

Each mL of Klaron (sodium sulfacetamide lotion) Lotion, 10% contains 100 mg of sodium sulfacetamide in a vehicle consisting of purified water; propylene glycol; lauramide DEA (and) diethanolamine; polyethylene glycol 400, monolaurate; hydroxyethyl cellulose; sodium chloride; sodium metabisulfite; methylparaben; xanthan gum; EDTA and simethicone.

Research Abstracts

Topical rosacea therapy: the importance of vehicles for efficacy, tolerability and compliance, J Drugs Dermatol. 2011 Jun 1;10(6):627-33, Jackson JM, Pelle M.

Many topical medications are available for the treatment of papulopustular rosacea. While treatments contain metronidazole, azelaic acid, or sodium sulfacetamide-sulfur as the active ingredient, the composition of the vehicle formulations varies widely.

These vehicles come in gels, creams, lotions and foams; some ingredients are common to many vehicles, while some vehicles contain unique ingredients designed to optimize skin penetration and delivery of the active drug to its target.

Vehicles can also influence tolerability, which is always a concern in patients with heightened skin sensitivity, and compliance, which is typically lower for topical treatments than oral treatments.

Ideally, the vehicle of any rosacea treatment should enhance drug delivery, be non irritating and be easy to use. Ingredients that help repair barrier function are also desirable. This review will focus on the key components of the vehicles from the most commonly used topical therapies for papulopustular rosacea and how vehicle formulations influence the delivery of active ingredient, skin barrier repair, tolerability and compliance.

Further related research;

THE IMPORTANCE OF VEHICLE IN ACNE THERAPY

Emil A. Tanghetti, MD, Chair, A Supplement to Skin & Allergy News,

Skin Disease Education Foundation’s 29th Annual Hawaii Dermatology Seminar, a continuing medical education program, March 18-24, 2005, in Maui, Hawaii. 

Physicians attempting to balance aggressive acne treatment with tolerability stress the importance of restoring hydration of the stratum corneum. Research demonstrating the stratum corneum’s pivotal role in drug delivery has sparked renewed interest in this topic.

Many common conditions directly and indirectly affect barrier function.  For example, atopic dermatitis, psoriasis, and acne affect barrier function directly through the impact of the inflammatory process on epidermal growth and maturation. Medications used to treat a number of conditions indirectly disrupt barrier function.  Topical retinoids—the mainstay of acne treatment—change and disrupt barrier function.

Several signs and symptoms characterize damage to the epidermal barrier.  Dryness and peeling occur when the water content of the stratum corneum falls below 10%.  This creates a damaged and leaky epidermis that may lead to overabsorption of topical medications and products, causing even more barrier damage.

Summary

Restoring and maintaining barrier function is critical for outcomes in patients with dermatologic diseases.  For optimal hydration, a vehicle that is both occlusive and humectant is ideal.  The addition of moisturizers such as dimethicone and glycerin to acne treatment products helps maintain barrier function and will provide better outcomes. This is particularly important when topical retinoids are included in the therapeutic regimen. For comedonal acne, combination products containing moisturizers may be effective first-line agents. Finally, clinicians should consider the vehicle prior to prescribing or recommending any products to patients with acne.

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Wouldn’t it be great if there was a simple answer to this question that satisfied everyone who has rosacea!

Hopefully it doesn’t come as a surprise to find out that there is no known panacea for rosacea.

This high level paper from The Journal of Family Practice seeks to summarise the available published research into rosacea treatments. Thus the treatments being labelled `best’ by this study are only ever going to be the ones that have been proven by years of research and development and real life testing.

What I’m trying to warm you up to is the idea that you should only ever expect to see the well known prescription topical and systemic treatments emerge from these sorts of studies.

Clinical Inquiries: What is the most effective treatment for acne rosacea?

J Fam Pract. 2011 Feb;60(2):108a-c., May D, Kelsberg G, Safranek S.

Topical metronidazole and azelaic acid are equally effective for the papulopustular lesions of acne rosacea, although metronidazole is better tolerated. Oral doxycycline, tetracycline, and metronidazole are also effective, but not enough evidence exists to determine whether one is more effective than another or more effective than topical therapy (strength of recommendation [SOR]: A, systematic review and individual randomized controlled trials [RCTs]).

Some evidence supports a benefit for topical sodium sulfacetamide with sulfur, and benzoyl peroxide (SOR: B, small single RCTs).

Pulsed-light and laser therapy may improve the erythema and telangiectasias associated with acne rosacea (SOR: C, case series).

All patients with acne rosacea should use sunscreen and emollients, and avoid skin irritants (SOR: C, expert opinion)

Recommendations

The American Acne and Rosacea Society guidelines state that good evidence supports topical treatments—metronidazole,
azelaic acid, and sulfacetamide/sulfur—as well as anti-inflammatory doses of oral doxycycline.

The guidelines also list other topical and oral antibiotic treatments, but cite low-quality evidence for their efficacy and concerns about the emergence of antibiotic resistance. They advise appropriate skin care, including gentle cleansers, moisturizers, and sun protection.    

Full Article PDF: What is the most effective treatment for acne rosacea?

Best Topical Therapy

Topical Metronidazole (Metrogel) and Azelaic Acid (Finacea) are indicated as being better than placebo, but “the studies
were generally weak because of poor methodology and reporting, small sample sizes, and lack of quality-of-life measures.”

Overall Metrogel is better tolerated than Finacea.

Best Systemic Therapy

Oral Metronidazole (Flagyl) and Oral Tetracycline as well as anti-inflammatory dose oral doxycycline (Periostat/Oracea) have been found to be effective.

Best Therapy for Redness

The best therapy for redness and broken blood vessels was found to be pulsed light therapy, laser therapy and photodynamic therapy with red light. No great surprises there.

Other Tips

“They advise appropriate skin care, including gentle cleansers, moisturizers and sun protection”. That is good advice we should all heed.

Can YOU Answer This Question?

Perhaps this paper won’t happily satisfy everyone’s quest for rosacea relief, but maybe you can.

You meet a newly diagnosed rosacea sufferer who is distressed. You have memories of being there yourself. What advice will you give them – what do you think is the best treatment for rosacea?

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Some press this week about an emerging diagnostic technology known as Raman Spectroscopy. Raman Spectroscopy looks at the way that light scatters when it interacts with different molecules. The technology can analyse the scatter patterns to determine exacting details to do with the chemical makeup of the tissue being examined.

The article suggests that Raman Spectroscopy can be used in a whole new range of ways in a diagnostic role.

Read on to find out how, in fact, this emerging technology has already been used in the development of rosacea treatments.

Painless laser device could spot early signs of disease

By Katia Moskvitch

Science reporter, BBC News

Portable devices with painless laser beams could soon replace X-rays as a non-invasive way to diagnose disease.

Researchers say that the technique could become widely available in about five years.

The method, called Raman spectroscopy, could help spot the early signs of breast cancer, tooth decay and osteoporosis.

Scientists believe that the technology would make the diagnosis of illnesses faster, cheaper and more accurate.

Raman spectroscopy is the measurement of the intensity and wavelength of scattered light from molecules.

It is already being used in the chemical and pharmaceutical industries. For instance, Raman lasers are used to measure flame characteristics. By studying how fuels burn, pollution from the products of combustion can be minimised.

…

When a person is sick, or about to become sick, the chemical mix in the tissue is quite different from that in healthy tissue, scientists say. So the Raman spectrum changes depending on the tissue it analyses, Professor Morris explained.

"Raman gives you a molecular fingerprint, a composition of whatever it is you’re measuring," he said.

"In diseased states, the chemical composition is either slightly abnormal or very markedly abnormal, depending upon the diseases."

How Raman is already being used

The application of Raman Spectroscopy to topical therapies is one example of where this new technology might lead to new products and treatments that are good for rosacea sufferers.

Indeed Raman has already been used to help understand how topical products interact with human skin.

Moisturizer Hydration

Rosacea News first mentioned this technology in 2006 in a study that attempted to measure how effectively the skin’s stratum corneum is hydrated by moisturizers. The 2006 study was interested in formulations of moisturizers that contain niacinamide (Vitamin B3). The sponsors of the study, Proctor & Gamble manufacture several products in the Olay Total Effects range that contain niacinamide. Additionally the new formulation of 1% Metrogel contains niacinamide.

RS was used to obtain accurate measurements of the amount of moisture in the stratum corneum.

Metrogel Absorption

Two studies featured by Rosacea News in 2007 looked at the way that metronidazole was absorbed by the skin.

metrogel: how it gets into your skin

Confocal Raman microspectroscopy is a nondestructive and rapid technique which allows information to be obtained from deep layers under the skin surface, giving the possibility of a real-time tracking of the drug in the skin layers. The specific Raman signature of the drug enables its identification in the skin. In this study, we try to follow the penetration of Metronidazole, a drug produced by Galderma as a therapeutic agent for Rosacea treatment, through the skin.

This technology allowed 6 different formulations of metronidazole to be evaluated. Then penetration of the cream formulations was found to be greater than the lotion and gel formulations.

The application of RS here will open the door to far more accurate analysis of topicals, ensuring that the correct vehicle will deliver the active ingredients to the tissue that will show maximum benefit.

The Future

Imagine if Raman Spectroscropy could be used to accurately diagnose rosacea. What a great achievement that would be. We can but dream.

Featured Product

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Seeing this abstract published makes me want to let out a loud groan.

So much of what we see as recently published rosacea research is just recycled sameness.  The actual result of most of these self-similar papers is pretty minimal.

It really doesn’t help rosacea sufferers much to know that the many permutations of the popular and already understood treatments all perform the same.

So the wheels on the bus go round and round, but on this route, the bus never seems to actually get anywhere.

Here is just a sample of the published research showing where this research bus is heading;

• Finacea + Oracea vs Metrogel + Oracea
• Finacea once per day vs Finacea twice per day
• Finacea + doxycyline and then just Finacea for maintenance
• Metrogel vs Finacea
• Metrogel vs Finacea 20%
• Metrogel vs. Finacea 15%
• Metrogel 1% once a day vs Finacea twice a day
• Oracea in combination with Metrogel
• Metrogel with and without antibiotics
• Oracea vs. Doxycycline
• Oracea + Metrogel vs. Doxycycline + Metrogel
• Combination Periostat + Metrogel
• Metrogel vs. Metrolotion vs. Metrocream vs. once a day vs. twice a day

This sort of research does provide good pharmaceutical marketing stories I guess and I suppose it justifies researchers’ efforts, but I am left wondering where this effort could be better utilised.

J Drugs Dermatol. 2010 Jun;9(6):607-13.

Efficacy of topical azelaic acid (AzA) gel 15% plus oral doxycycline 40 mg versus metronidazole gel 1% plus oral doxycycline 40 mg in mild-to-moderate papulopustular rosacea.

Del Rosso JQ, Bruce S, Jarratt M, Menter A, Staedtler G.

Rosacea is a leading reason why people seek the care of a dermatologist, accounting for nearly 7 million office visits annually. Pharmacologic treatments include both topical and oral medications, which are increasingly being used in combination, especially at the outset of therapy. This exploratory study assesses the safety, effectiveness and speed of onset of two common topical agents for the treatment of rosacea azelaic acid gel (AzA) 15% and metronidazole gel 1% used in conjunction with anti-inflammatory dose doxycycline (40 mg once daily). Men and women (n = 207) with mild-to-moderate papulopustular rosacea were enrolled and randomized to receive either AzA gel 15% twice daily plus doxycycline 40 mg once daily (AzA group) or metronidazole gel 1% once daily plus doxycycline 40 mg once daily (Metro group) for 12 weeks. Both regimens were safe, efficacious and well tolerated. Efficacy parameters revealed a possible trend toward greater and earlier benefit with the AzA-based regimen than with the metronidazole-based regimen. These findings warrant further investigation in a sufficiently powered study.

I’ll end this note with a comment that why, seriously, would this study encourage the creation of a more detailed study ?

Being prescription items, Oracea and Metrogel 1% are too expensive for many rosacea sufferers, even those with basic medical insurance.

Thanks to a tip from chenoarae; Oracea and Metrogel 1% are both available for free for residents of the US who don’t have insurance of any sort and are on a low income.

Some pharmaceutical companies offer a Patient Assistance Program (PAP) where they provide their products for free or for a much reduced rate to individuals or families who are under-insured or uninsured.

Thankfully for rosacea sufferers, Galderma offers such a program and generously includes both Metrogel 1% 60gm and Oracea 40mg.

Do I qualify ?

If there is just 1 person in your household, and your incoming including social security and pension benefits is less than $21,660 then you may qualify for the Patient Assistance Program. The income limit is $29,140 for a couple and $36,620 for a household of 3, $44,100 for a household of 4.

Further, the following additional requirements are applied;

• Medicare Part D enrollees are not eligible.
• Patient must not qualify/or must not be eligible for any private insurance prescription coverage such as an HMO or PPO.
• Patient must not be enrolled in Medicare Part D, and must not qualify to any state/federal assistance with prescription medications.

The drugs are supplied only for the use of the patient, who has a medical need and cannot afford them. We are also told that they are not to be sold or traded.

How do I apply ?

The application form needs to be signed by your doctor and faxed to the Galderma PAP for each prescription fill.

Print the following form: Patient Assistance Program Enrollment Application and take it to your doctor to sign and fax along with the supporting documentation to Galderma in Chicago.

You may also like to include the PAP Physician Instructions for your doctor’s information.

Within 8 days of the application you will receive a prescription card that will enable you to pick up your prescription at any local pharmacy.

Are there other options ?

If you don’t qualify for this program you may find that generic metrogel or 50mg a day of generic doxycycline offer you similar benefits to the branded treatments at a much reduced cost.

Galderma also offers an Oracea and Metrogel 1% Coupon program it calls the Oracea Savings Card and Metrogel 1% Co-pay Card.

The Oracea Savings Card will allow you to co-pay as little as $15 a month or even a $0 co-payment. You will need comprehensive medical insurance for this option of course.

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