for placebo in SC1401 and SC1402, respectively. This outcome was also similar for the chest with 29.6% and 36.6% efficacy in the sarecycline group vs 19.6% and 21.6% in the placebo group. Pooled results by Del Rosso et al further showed that both chest and back IGA success rates were significantly greater vs placebo as early as week 3.74
Trifarotene
Trifarotene is a fourth-generation retinoid that is selective for retinoic acid receptor (RAR)-y. The 0.005% cream (Aklief) has been approved for the topical treatment of acne vulgaris in patients 9 years of age or older.75 The phase 3 trials leading to approval of trifarotene were the first to evaluate the truncal acne reductions as an official endpoint using the PGA.5 In two double-blind, randomized, vehicle-controlled studies of trifarotene cream applied once daily (PERFECT 1 and PERFECT 2), patients ages 9 years or older with moderate truncal acne (PGA score of 3) and ≥20 inflammatory lesions and 20 to <100 noninflammatory lesions were included. The co-secondary efficacy endpoints were defined as the percentage of subjects achieving a PGA rating of clear or almost clear and at least a 2-grade change from baseline to week 12 as well as absolute changes in truncal inflammatory and noninflammatory lesion counts from baseline to week 12. Across both trials, a total number of 1,198 patients received trifarotene cream, and 1,194 received vehicle cream. Truncal PGA success was achieved by 35.7% in PERFECT 1 and 42.6% in PERFECT 2 in the trifarotene group vs 25.0% and 29.9% for vehicle, respectively. Significantly greater reductions in inflammatory and noninflammatory lesion counts were also observed in the trifarotene treatment group compared to vehicle. A post-hoc analysis of these 2 trials focusing on adolescent patients aged 12 to 17 years old (N= 1,128) revealed success rates on PGA at week 12 to be 35.1% in the trifarotene group and 23.5% in the vehicle group with a statistically significant difference (P<0.001).76 A 52-week, openlabel, non-comparative trial of once-daily trifarotene cream for facial and truncal acne vulgaris was also conducted.77 A total of 348 patients completed the study. PGA success rates for truncal acne were 38.6% at week 12, 58.4% at week 26, and 66.9% at week 52. Overall, it is evident that extended use of trifarotene results in greater success for truncal acne.
Tazarotene
In addition to trifarotene, tazarotene is a third-generation retinoid that targets RARβ and RARγ that was originally approved for plaque psoriasis 25 years ago.78 Different topical formulations have been tested in patients with facial acne vulgaris with significant lesion reductions observed after 12 weeks of treatment with 0.045% lotion.79-80 Its use specifically for truncal acne has recently been explored. Jarratt et al found good efficacy for tazarotene foam or gel for acne of the chest, upper back, and shoulders.81 A single-center, open-label 12- week pilot study of tazarotene 0.045% lotion (Arazlo, Ortho Dermatologics) for truncal was recently conducted.82 A total of 19 subjects (10 females, 9 males, aged 12 to 58 years) completed the study. Subjects with moderate severity of truncal acne (IGA 3) were included, and the primary endpoint was the percent of patients achieving ≥2-grade improvement on the IGA scale and achieving a final IGA score of clear or almost clear. At week 4, 21% of patients achieved clear/almost clear skin. By week 12, 89% of patients achieved the primary endpoint. In addition, there was a significant improvement in the Dermatology Life Quality Index (DLQI) from a mean of 4.2 at baseline of 1.7 at week 12. DLQI measurements were not included in any of the trifarotene studies to date.
While both tazarotene and trifarotene are topical retinoids with demonstrated efficacy against truncal acne, it is important to consider patient compliance as there are also difficulties in maintaining a topical treatment regimen over large surface areas such as the back and chest compared to the face. Tazarotene 0.045% lotion was developed in a unique optimized vehicle using polymeric emulsion technology where a 3-D mesh allows for a uniform distribution and moisturizing/hydrating agents.83 Using this first-in-class vehicle technology, in the open-label study of 19 adults, 73% of subjects rated tazarotene 0.045% lotion as having excellent ease of use compared to previous topical therapies, 72% rated as excellent with regard to continuation of daily activities, and 59% rated as excellent with regard to large surface area application.82 Sixty-five percent of patients also rated its spreadability as excellent. A single case of series of 3 subjects that assessed real-world patient satisfaction with application of trifarotene cream once daily for truncal acne also revealed high overall satisfaction and excellent tolerability.84
A recent double-blind, split-body study of 30 healthy adults aged 18 to 59 years further demonstrated the superior spreadability of tazarotene 0.045% lotion over trifarotene 0.005% cream.85 A total 0.1 mL of each product was applied to a 10 cm wide area on 1 side of the back and pulled down the back until it could no longer spread, after which the area of spread was measured. The mean area of spread for tazarotene 0.045% lotion and trifarotene 0.005% cream were 167.0 cm2 and 130.3 cm2, respectively. On average, skin coverage with tazarotene lotion was ~30% greater than with trifarotene cream. This study was the first head-tohead comparison of topical retinoid spreadability and highlights the advantage of tazarotene's polymeric emulsion technology for vehicle formation. As such, patients may be more likely to use topicals with greater ease of use and spreadability, which could in turn increase compliance and achieve better outcomes.
Trifarotene
Trifarotene is a fourth-generation retinoid that is selective for retinoic acid receptor (RAR)-y. The 0.005% cream (Aklief) has been approved for the topical treatment of acne vulgaris in patients 9 years of age or older.75 The phase 3 trials leading to approval of trifarotene were the first to evaluate the truncal acne reductions as an official endpoint using the PGA.5 In two double-blind, randomized, vehicle-controlled studies of trifarotene cream applied once daily (PERFECT 1 and PERFECT 2), patients ages 9 years or older with moderate truncal acne (PGA score of 3) and ≥20 inflammatory lesions and 20 to <100 noninflammatory lesions were included. The co-secondary efficacy endpoints were defined as the percentage of subjects achieving a PGA rating of clear or almost clear and at least a 2-grade change from baseline to week 12 as well as absolute changes in truncal inflammatory and noninflammatory lesion counts from baseline to week 12. Across both trials, a total number of 1,198 patients received trifarotene cream, and 1,194 received vehicle cream. Truncal PGA success was achieved by 35.7% in PERFECT 1 and 42.6% in PERFECT 2 in the trifarotene group vs 25.0% and 29.9% for vehicle, respectively. Significantly greater reductions in inflammatory and noninflammatory lesion counts were also observed in the trifarotene treatment group compared to vehicle. A post-hoc analysis of these 2 trials focusing on adolescent patients aged 12 to 17 years old (N= 1,128) revealed success rates on PGA at week 12 to be 35.1% in the trifarotene group and 23.5% in the vehicle group with a statistically significant difference (P<0.001).76 A 52-week, openlabel, non-comparative trial of once-daily trifarotene cream for facial and truncal acne vulgaris was also conducted.77 A total of 348 patients completed the study. PGA success rates for truncal acne were 38.6% at week 12, 58.4% at week 26, and 66.9% at week 52. Overall, it is evident that extended use of trifarotene results in greater success for truncal acne.
Tazarotene
In addition to trifarotene, tazarotene is a third-generation retinoid that targets RARβ and RARγ that was originally approved for plaque psoriasis 25 years ago.78 Different topical formulations have been tested in patients with facial acne vulgaris with significant lesion reductions observed after 12 weeks of treatment with 0.045% lotion.79-80 Its use specifically for truncal acne has recently been explored. Jarratt et al found good efficacy for tazarotene foam or gel for acne of the chest, upper back, and shoulders.81 A single-center, open-label 12- week pilot study of tazarotene 0.045% lotion (Arazlo, Ortho Dermatologics) for truncal was recently conducted.82 A total of 19 subjects (10 females, 9 males, aged 12 to 58 years) completed the study. Subjects with moderate severity of truncal acne (IGA 3) were included, and the primary endpoint was the percent of patients achieving ≥2-grade improvement on the IGA scale and achieving a final IGA score of clear or almost clear. At week 4, 21% of patients achieved clear/almost clear skin. By week 12, 89% of patients achieved the primary endpoint. In addition, there was a significant improvement in the Dermatology Life Quality Index (DLQI) from a mean of 4.2 at baseline of 1.7 at week 12. DLQI measurements were not included in any of the trifarotene studies to date.
While both tazarotene and trifarotene are topical retinoids with demonstrated efficacy against truncal acne, it is important to consider patient compliance as there are also difficulties in maintaining a topical treatment regimen over large surface areas such as the back and chest compared to the face. Tazarotene 0.045% lotion was developed in a unique optimized vehicle using polymeric emulsion technology where a 3-D mesh allows for a uniform distribution and moisturizing/hydrating agents.83 Using this first-in-class vehicle technology, in the open-label study of 19 adults, 73% of subjects rated tazarotene 0.045% lotion as having excellent ease of use compared to previous topical therapies, 72% rated as excellent with regard to continuation of daily activities, and 59% rated as excellent with regard to large surface area application.82 Sixty-five percent of patients also rated its spreadability as excellent. A single case of series of 3 subjects that assessed real-world patient satisfaction with application of trifarotene cream once daily for truncal acne also revealed high overall satisfaction and excellent tolerability.84
A recent double-blind, split-body study of 30 healthy adults aged 18 to 59 years further demonstrated the superior spreadability of tazarotene 0.045% lotion over trifarotene 0.005% cream.85 A total 0.1 mL of each product was applied to a 10 cm wide area on 1 side of the back and pulled down the back until it could no longer spread, after which the area of spread was measured. The mean area of spread for tazarotene 0.045% lotion and trifarotene 0.005% cream were 167.0 cm2 and 130.3 cm2, respectively. On average, skin coverage with tazarotene lotion was ~30% greater than with trifarotene cream. This study was the first head-tohead comparison of topical retinoid spreadability and highlights the advantage of tazarotene's polymeric emulsion technology for vehicle formation. As such, patients may be more likely to use topicals with greater ease of use and spreadability, which could in turn increase compliance and achieve better outcomes.
