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Efficacy of tetracyclines in the treatment of acne vulgaris: a review.

Efficacy of tetracyclines in the treatment of acne vulgaris: a review

Simonart T, Dramaix M and De Maertelae V

Br J Dermatol, 2008, 158, 208-216

Therapeutic intervention methods for acne commonly include antibiotics and there is a wide range of options available, both topical and oral. Efficacy of antibiotic treatment for acne is very good, especially for inflammatory acne, and antibiotics are frequently used in combination with all-trans retinoic acid for non-inflammatory acne. Increased bacterial activity within the pilosebaceous unit is known to be one of the four key contributing factors in acne pathogenesis.

This paper describes a systematic review of the clinical trials from 1962 to 2002 investigating the use of oral tetracyclines for the treatment of inflammatory acne. Data was obtained from MEDLINE, PubMed, Current Contents, reference lists and specialist textbooks. Selected keywords were: acne, antibiotic, treatment, tetracycline, oxytetracycline, minocycline, lymecycline, doxycycline and clinical trial. All trials investigating treatment of mild to moderate acne were considered. Trials were excluded if duplicated, if on the treatment of severe nodulocystic acne, if on fewer than six patients or if they included therapies other than tetracyclines, that is combination treatment of acne. Data was extracted and analysed using several quality indicators including year of publication, percentage of subjects not evaluated after treatment, and efficacy of treatment as expressed when the proportion of reduction in inflammatory and non-inflammatory lesion counts was compared.

Forty-eight clinical trials between the years 1962 and 2002 were identified for data mining. Twenty-nine trials investigated minocycline, 10 trials investigated doxycycline and 7 trials investigated lymecycline. There was substantial heterogeneity in the design of the trials. Only seven trials were identified as being set up to compare the efficacy of tetracyclines in reducing acne lesion counts. These showed no evidence of superiority of one tetracycline over another. Overall, therefore, no difference was detected between tetracyclines in terms of improving non-inflammatory and inflammatory lesion counts. Dosage appeared to have no effect on efficacy of therapy and there was no decrease in efficacy during the study period.

Analysis of published clinical trial data is often useful for multiple reasons, although the integrity of the data collected can be compromised due to the wide variation in study designs and study populations. Judicious selection of data from the studies is required to extract useful information and draw 'quality' conclusions. This study concluded that there is insufficient data to support selection of one tetracycline over another in terms of efficacy, and that dosage appeared to have no impact on treatment outcome. An interesting finding was that no decrease in response to treatment was noted over the study period. Since there are many concerns of increasing resistance to antibiotics, it might be expected that a decrease in efficacy would be noted. This was not the case. Another interesting observation was based on the different lengths of clinical studies. Most studies had endpoints between 8 and 12 weeks: longer administration periods were not associated with higher clinical efficacy.
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Author:Knaggs, H.E.
Publication:Clinical Dermatology
Date:Dec 1, 2008
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