Rosacea Treatment Satisfaction: Matching Adjusted Indirect Treatment Comparison Analysis of Metronidazole Gel or Cream vs Azelaic Acid Foam

March 2020 | Volume 19 | Issue 3 | Original Article | 295 | Copyright © March 2020

Published online February 21, 2020

Todd Williamson MSc,a Anneliese LaRose MS,a Jennifer Cameron MHA,a Jason Lott MD FAAD,a Michael Eaddy PharmD PhD,b Sari Hopson PhD MSPH,b Huai-Che Shih PhD,b Linnea Tennant PharmD MBA MSb

aBayer HealthCare Pharmaceuticals Inc., Whippany, NJ bXcenda, Palm Harbor, FL

Objective: To assess differences in patient-reported treatment side effects and concerns associated with azelaic acid 15% foam (AAF) vs metronidazole cream (MC) and metronidazole gel (MG).
Methods: This study used matching-adjusted indirect comparison (MAIC) to compare patient-reported outcomes from survey data evaluating rosacea treatments. Outcomes of interest included percentages of patients reporting concerns and side effects and measures of importance of the concerns and tolerability of the side effects. Patients in each analysis (MG vs AAF and MC vs AAF) were matched using stabilized inverse propensity scores.
Results: When compared to AAF, MG-treated patients more frequently reported concerns with treatment efficacy (54% vs 4%), application (7% vs 3%), and treatment side effects. MC-treated patients more frequently reported concerns with treatment efficacy (61% vs 5%) and dryness (8% vs 5%). AAF-treated patients more frequently reported concerns with cost of treatment compared with MG (7% vs 1%) and MC (9% vs 4%). Among patients reporting concerns, level of importance associated with these concerns was similar for AAF-treated patients compared with MG- and MC-treated patients. When compared to AAF-treated patients, MG-treated patients more frequently reported side effects of dryness (26% vs 15%) and uneven skin tone (3% vs 0%), and MC-treated patients more frequently reported side effects of burning (7% vs 3%), itching (7% vs 5%), and redness (7% vs 5%). MG- and MC-treated patients indicated greater intolerance for reported side effects than AAF-treated patients.
Conclusions: MG- and MC-treated patients more frequently reported treatment concerns and side effects than AAF-treated patients, and tolerability of those side effects was higher for patients treated with AAF. While treatment cost is a more frequent concern in patients treated with AAF, these patients less frequently reported concerns with treatment efficacy and reported similar or greater tolerance to side effects than patients treated with either MC or MG.

J Drugs Dermatol. 2020;19(3): doi:10.36849/JDD.2020.3679


Rosacea is a chronic, inflammatory dermatosis primarily affecting the central face that affects approximately 10% of adults,1,2 with higher rates in women and those with Fitzpatrick skin Types I to II.1,3,4 Onset of rosacea most often occurs after age 30; however, it may occur at any age and is characterized by repeated remissions and exacerbations.5 Characteristics of clinical manifestations dictate treatment decisions for rosacea, and several topical pharmacological interventions are indicated for the treatment of mild to moderate rosacea.1

First-line treatment options for mild to moderate rosacea typically include metronidazole and azelaic acid. These therapies have demonstrated efficacy compared to placebo in reducing inflammatory lesions but with increasing incidence of topical irritations. Given the availability of multiple agents with proven efficacy, clinicians and patients may consider additional information to guide therapeutic decision-making, including side effect profile and a treatment’s effect on quality of life (QoL).

Previous research has shown that rosacea patients initiated on topical therapies who experience side effects are likely to discontinue treatment: ~90% discontinue within the first 3 months of therapy.6 Currently, there is a lack of head-to-head trials comparing treatment satisfaction among rosacea patients using the first-line treatment options for mild to moderate rosacea: metronidazole gel (MG), metronidazole cream (MC), and azelaic acid 15% foam (AAF) (Finacea® Foam, Bayer).

Two independently conducted treatment studies assessed patient preference with ongoing rosacea treatment.7,8 In each