severe AV.9 A total of 459 subjects were randomized in a 1:1 ratio
to receive for 12 weeks oral doxycycline once daily or either
Epiduo or a vehicle gel once daily. The efficacy of doxycycline
and Epiduo was demonstrated by week 2 compared with the vehicle
arm for total inflammatory and noninflammatory lesions.9
By week 12, the doxycycline and Epiduo group was superior
to vehicle in reducing total inflammatory and noninflammatory
lesion counts and for global success and overall participant satisfaction.
9 Digital UV fluorescence photography also showed an
expeditious and efficacious reduction to P. acnes in the doxycycline
and Epiduo group (Figure 3).9
Whereas ACCESS I focused on the primary treatment of acne
with Epiduo, ACCESS II evaluated the safety and efficacy of
Epiduo for maintenance therapy or relapse prevention.10 ACCESS
II was a 24-week, multicenter, double-blind, randomized
extension of ACCESS I that compared Epiduo with vehicle in
243 subjects. After the randomized subjects were treated for
12 weeks in ACCESS I, and had experienced at least a 50%
global improvement in their AV, they were randomized to receive
Epiduo gel or its vehicle once daily for 24 weeks.10 By
week 24, when Epiduo was compared with vehicle, it yielded
a significantly higher lesion maintenance success rate for all
lesions; and a significantly greater number of subjects who
had been administered Epiduo had an equivalent or superior
Investigator’s Global Assessment score at week 24 than at
baseline.10 In ACCESS II, Epiduo resulted in further decrease
of lesion counts, and 45.7% of subjects were “clear†or “almost
clear†at week 24 (Figure 4).10,11
Leyden et al evaluated the effectiveness of adapalene and
BPO combination gel in the reduction of antibiotic-sensitive
and resistant strains of P. acnes on the facial skin. This 4-week,
open-label, single-center study included 30 healthy adults
with high facial P. acnes populations that were resistant to one
or more of the following antibiotics: erythromycin, tetracycline,
clindamycin, minocycline, and doxycycline.12 Although
all of the subjects had P. acnes strains resistant to one or more
of the 5 antibiotics at baseline, the total P. acnes counts decreased
by 1.1 logs after 2 weeks of treatment and by 1.6 logs
after 4 weeks.12 In addition to reducing population densities
of P. acnes, adapalene and BPO combination gel completely
eradicated antibiotic resistant strains in some subjects.12
