title: A multicentre, randomized, single-blind, parallel-group study comparing the efficacy and tolerability of benzoyl peroxide 3%/clindamycin 1% with azelaic acid 20% in the topical treatment of mild-to-moderate acne vulgaris.
abstract: BACKGROUND
  Mild-to-moderate acne vulgaris is treated with a range of mono- and combination therapies; however, clinical evidence is still required to optimize treatment recommendations.
  
  
  OBJECTIVE
  To compare the efficacy, tolerability and safety of a combination of benzoyl peroxide 3% and clindamycin 1% (BPO + CLN) with azelaic acid 20% (AzA) for the topical treatment of mild-to-moderate acne vulgaris.
  
  
  METHODS
  This was a randomized, assessor-blinded, parallel-group, multicentre study conducted in Germany. Patients with a confirmed diagnosis of acne vulgaris, aged 12-45 years, were randomized 1 : 1 to once-daily BPO + CLN gel or twice-daily AzA cream for up to 12 weeks. The primary endpoint was the percentage change in inflammatory lesions from baseline at Week 4. Secondary endpoints included total and inflammatory lesion counts and tolerability assessments. For selected secondary endpoints, inductive statistical analysis was performed post hoc. Patient safety was assessed by adverse event (AE) monitoring.
  
  
  RESULTS
  Efficacy was assessed in the modified intent-to-treat (mITT) population [patients using ≥1 dose of study medication (ITT), plus baseline and ≥1 post-baseline lesion count (n = 215)]. There was a statistically significant difference in the primary endpoint, with a median decrease of -52.6% for BPO + CLN (n = 107) vs.-38.8% for AzA (n = 108; P = 0.0004). There was also a greater difference in secondary lesion endpoints at Week 12, with a median decrease in inflammatory lesions of -78.8% and -65.3% and total lesions of -69.0% and -53.9% with BPO + CLN and AzA, respectively (both P < 0.0001). Tolerability was acceptable for both treatments. Overall, 55.6% (BPO + CLN) and 69.7% (AzA) of patients reported treatment-emergent AEs, and 15.7% and 35.8% of patients experienced application site reactions with BPO + CLN (24 events; 17 patients) and AzA (60 events; 39 patients) treatment, respectively (ITT population).
  
  
  CONCLUSIONS
  BPO + CLN demonstrated greater efficacy than AzA in the treatment of mild-to-moderate acne vulgaris and has a positive tolerability and safety profile.
authors.affiliation: Department of Dermatology, University of Tübingen, Tübingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schaller
authors.affiliation: Hautarztpraxis Mahlow, Mahlow, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Sebastian
authors.affiliation: GlaxoSmithKline Germany, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Ress
authors.affiliation: GlaxoSmithKline Germany, Munich, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Seidel
authors.affiliation: GlaxoSmithKline Germany, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hennig
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy*; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D001585:Benzoyl Peroxide / Q000008:administration & dosage*; D002648:Child; D002981:Clindamycin / Q000008:administration & dosage*; D003998:Dicarboxylic Acids / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D006801:Humans; D008875:Middle Aged; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D003998:Dicarboxylic Acids; D002981:Clindamycin; C010038:azelaic acid; D001585:Benzoyl Peroxide