title: How Much Do We Know about Maintaining Treatment Response after Successful Acne Therapy? Systematic Review on the Efficacy and Safety of Acne Maintenance Therapy.
abstract: After cessation of successful initial acne therapy, patients often experience flares. Consecutive maintenance treatment after successful induction therapy is promoted by guidelines; however, little is known about the efficacy/safety of different maintenance regimens. A systematic review on acne maintenance treatments was conducted. We identified 5 randomized controlled trials [RCTs; adapalene vs. vehicle or vs. no treatment (3 RCTs), adapalene/benzoyl peroxide (BPO) vs. vehicle, combination/monotherapy of minocycline (systemic)/tazarotene/placebo] and 3 non-RCTs on systemic isotretinoin, adapalene/BPO and azelaic acid. The results of adapalene versus vehicle/no treatment varied depending on the reported outcome. The 'number of patients maintaining at least 50% improvement' counting inflammatory lesions/non-inflammatory lesions with adapalene was superior to vehicle (risk ratio, RR 1.24, 95% confidence interval, CI 1.08-1.43/RR 1.34, 95% CI 1.18-1.59). However, no significant differences were found in 2 of 3 RCTs for maintaining 'clear/almost clear' or 'mild acne' or on the global grading score. For the combination regimens of minocycline/tazarotene/placebo, no significant differences were found. Adapalene/BPO was superior to vehicle counting inflammatory lesions/non-inflammatory lesions (RR 1.61, 95% CI 1.31-1.99; RR 1.80, 95% CI 1.44-2.26). Due to the scarcity of studies, few conclusions can be drawn. More homogeneous outcome measures and specific maintenance study designs may lead to more robust findings.
authors.affiliation: Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Charitx00E9; - Universitx00E4;tsmedizin Berlin, Berlin, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Dressler
authors.forename: Stefanie
authors.initials: S
authors.lastname: Rosumeck
authors.forename: Alexander
authors.initials: A
authors.lastname: Nast
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy*; D000068816:Adapalene / Q000008:administration & dosage; D000279:Administration, Cutaneous; D001585:Benzoyl Peroxide / Q000008:administration & dosage; D003879:Dermatologic Agents / Q000008:administration & dosage*; D005782:Gels; D006801:Humans; D015474:Isotretinoin / Q000008:administration & dosage; D009539:Nicotinic Acids / Q000008:administration & dosage; D016896:Treatment Outcome; D012176:Retinoids
chemical_list: D000068816:Adapalene; D001585:Benzoyl Peroxide; D003879:Dermatologic Agents; D005782:Gels; D015474:Isotretinoin; D009539:Nicotinic Acids; C086827:tazarotene; D012176:Retinoids