Pearls of Wisdom: Cost Effective Acne Treatments

Answer: Benzoyl peroxide.

When I first encountered the terms efficacy and effectiveness in evidence-based medicine literature, I was somewhat off-put by the concept that results seen in our offices were anticipated to be less favorable than those seen in clinical trials. Note: The results seen in a clinical trial are termed efficacy, while the results anticipated in a typical clinical setting, which are termed effectiveness.

Efficacy vs Effectiveness

Let’s first discuss the underlying premises to these concepts.

Clinical trials are, in many ways, artificial. Patients who volunteer for clinical trials often demonstrate substantial differences from the general public. When patients enter a clinical trial, many are excluded because of characteristics that might confound the trial. Often, medications are provided free-of-charge; in some circumstances, patients have been incentivized (eg, paid) to participate.

These same resources may not be available in the typical clinician’s office. While there may be teams of support personnel (eg, nutritionists, behavioral health specialists, and exercise counselors) available on clinical trials, these same staff may or may not be available in the average clinician’s office. Furthermore, regimentation of follow-up, identification of problems that might lead to nonadherence, and frequent patient contact may be more intensive in a clinical trial than in a community practice.

Any or all of these factors provide substance to the concept that results obtained in a clinical trial, which are usually based at University centers, tertiary care hospitals, centers of excellence, etc., might be rightly anticipated to reflect the best of all worlds, whereas our offices better represent “the real world.”

By understanding the science behind the hierarchy of efficacy versus effectiveness, there is less just cause to feel defensive about the comparison.

The Research

Acne commonly presents in primary care settings, so it’s nice to have data specifically derived from the community setting. In one community-based study, a randomized 18-week trial assigned the 649 adolescent participants to 1 of 5 regimens: benzoyl peroxide, minocycline, oxytetracycline, or 2 forms of benzoyl peroxide + erythromycin.¹

Researchers found that efficacy outcomes of each treatment arm were quite similar. There was only a single statistically significant outcome, and it was not of sufficient clinical relevance to be meaningful. Hence, the least expensive regimen (benzoyl peroxide) was just as effective as the most expensive treatment (minocycline).

What’s the “Take Home”?

Benzoyl peroxide proved to be the most cost-effective acne regimen, and is a reasonable foundation treatment for mild-moderate adolescent acne.

Reference:

1. Ozolins M, Eady EA, Avery AJ, et al. Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial. Lancet. 2004;364(9452):2188-2195.