This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo
Clinical Summary

Ivermectin is an effective option for papulopustular rosacea

Takeaway

  • Systematic review (5 studies) suggests topical ivermectin is more effective in the treatment of papulopustular rosacea vs other treatment options.
  • Treatment guidelines, however, do not prefer one agent to another.

Key points

  • Ivermectin vs vehicle (2 studies):
    • Inflammatory lesion counts reduced significantly with ivermectin (mean change, −8.13 and −8.22).
    • Ivermectin was more effective in achieving Investor Global Assessment (IGA) score ≤1 at 12 weeks (38.4% vs 11.6% and 40.1% vs 18.8%).
    • Patients rating their rosacea improvement as ‘‘excellent’’ or ‘‘good’’ after 12 weeks were higher with ivermectin (69.0% vs 38.6% and 66.2% vs 34.4%).
    • Similarly, in 40 weeks extension study, higher proportion of patients receiving ivermectin had an IGA score ≤1 (71.1% vs 59.4% and 76.0% vs 57.9%).
    • Cochrane review of the studies reported better patient- and physician-rated improvement in rosacea severity with ivermectin vs vehicle.
  • Ivermectin vs metronidazole (1 study):
    • Ivermectin significantly reduced the inflammatory lesion count at 16 weeks of treatment (83.0% vs 73.7%), was more effective in achieving IGA scores ≤1 (84.9% vs 75.4%) and had higher number of patients reporting rosacea improvement as “good/excellent” (85.5% vs 74.8%).
    • In 36-week extension study, ivermectin showed longer median time to first relapse (115 vs 85 days) with lower relapse rate (62.7% vs 68.4%).
  • In a network meta-analysis:
    • At 12 weeks, ivermectin showed significantly greater likelihood of IGA scores ≤1 vs azelaic acid (relative risk [RR], 1.25; 95% CI, 1.14-1.37) and metronidazole (RR, 1.17, 95% CI, 1.08-1.29).
    • At 12 weeks, ivermectin significantly reduced inflammatory lesion count vs azelaic acid 15% gel (mean difference [MD], −8.04; 95% CI, −12.69 to −3.43) and metronidazole (MD,  −9.92; 95% CI, −13.58 to −6.35).
  • Treatment guidelines recommend ivermectin, metronidazole or azelaic acid as the first-line treatment in mild-to-moderate papulopustular rosacea. No agent is preferred over another.
  • No major safety issues were reported.

References


YOU MAY ALSO LIKE