 |
The just published update to the 2011 Cochrane review of interventions for rosacea has given its opinion on the last 4 years of published rosacea research. Previous Cochrane reviews on rosacea interventions have been published in 2004, 2005 and 2011. This review looked at 106 randomized clinical trials with 13,631 participants.
Cochrane Review Results
The most relevant result is that the active ingredients in Oracea, Mirvaso and Soolantra have been shown to be soundly proven as effective treatments. Good news for Galderma I guess. Galderma must be happy that their R&D investment in rosacea has turned out pretty well for them.
Here in dot points are the main outcomes of this systematic review.
Topical Treatments
- topical metronidazole appeared to be more effective than placebo (moderate quality evidence)
- azelaic acid appeared to be more effective than placebo (high-quality evidence)
- topical ivermectin was more effective than placebo based on two studies (high-quality evidence), and slightly more effective than metronidazole in one study
- Brimonidine was more effective than vehicle in reducing erythema in rosacea (high-quality evidence)
- Ciclosporin ophthalmic emulsion was effective for ocular rosacea (low-quality evidence).
Oral Treatments
- high-quality evidence for doxycycline 40 mg compared with placebo according to physician assessments.
- Low-dose isotretinoin (0.3 mg kg-1) appeared to be slightly more effective than doxycycline 50–100 mg (high-quality evidence).
Laser Treatments
- Laser and light-based therapies for erythema in rosacea were effective (low-quality evidence)
Poor evidence and not proven
- inconsistent results regarding effectiveness and safety in the comparison of topical metronidazole vs. azelaic acid (low-quality evidence).
- Four studies showed no statistically significant difference for any outcome in the comparison of topical metronidazole and oral tetracycline (moderate-quality evidence).
- There was low-quality evidence for ciclosporin ophthalmic emulsion for ocular rosacea.
- moderate-quality evidence that a combination of clindamycin and tretinoin was not more effective than placebo
- low-quality evidence that minocycline 45 mg may be effective
Cochrane Systematic Review Abstract
Interventions for rosacea: abridged updated Cochrane systematic review including GRADE assessments
Br J Dermatol. 2015 Sep;173(3):651-62, E.J. van Zuuren and Z. Fedorowicz
Rosacea is a common chronic facial dermatosis. This update of our Cochrane review on interventions for rosacea summarizes the evidence, including Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group assessments, of the effects of the currently available treatments. Searches included the following: Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE, EMBASE, LILACS and the Science Citation Index, and ongoing trials registries (July 2014).
We included 106 randomized controlled trials (RCTs) with 13 631 participants, a more than 80% increase since the last update in 2011.
Pooling of data was feasible for a few outcomes, for topical metronidazole and azelaic acid and both appeared to be more effective than placebo (moderate and high-quality evidence, respectively).
Topical ivermectin was more effective than placebo based on two studies (high-quality evidence), and slightly more effective than metronidazole in one study.
Brimonidine was more effective than vehicle in reducing erythema in rosacea (high-quality evidence).
Ciclosporin ophthalmic emulsion was effective for ocular rosacea (low-quality evidence).
For oral treatments there was moderate-quality evidence for the effectiveness of tetracycline based on two old studies, and high-quality evidence for doxycycline 40 mg compared with placebo according to physician assessments. One study at high risk of bias demonstrated equivalent effectiveness for azithromycin and doxycycline 100 mg. Minocycline 45 mg may be effective for papulopustular rosacea (low-quality evidence). Low-dose isotretinoin appeared to be slightly more effective than doxycycline 50-100 mg (high-quality evidence).
Laser and light-based therapies for erythema in rosacea were effective (low-quality evidence). Further RCTs are required for ocular rosacea.
