Oral isotretinoin was the most effective treatment, followed in efficacy by a triple therapy containing a topical antibiotic, a topical retinoid and benzoyl peroxide (BPO), and another triple therapy containing an oral antibiotic, a topical retinoid and BPO.

Oral isotretinoin, followed by topical antibiotic, benzoyl peroxide and retinoid, are most effective acne treatments, according to a network meta-analysis of 221 randomized controlled trials.

For the study, researchers investigated the effectiveness of various pharmacological therapies for acne vulgaris across diverse age groups and genders. The articles described 37 interventions, with a median patient age of 20 years old and median duration of treatment of 12 weeks. The median total, inflammatory and non-inflammatory lesion counts were 71.5, 27 and 44, respectively.

Oral isotretinoin was the most effective treatment, followed in efficacy by a triple therapy containing a topical antibiotic, a topical retinoid and benzoyl peroxide (BPO), and another triple therapy containing an oral antibiotic, a topical retinoid and BPO.  For monotherapies besides isotretinoin, antibiotics or topical retinoids have comparable efficacy for inflammatory lesions, while antibiotics have less effect on non-inflammatory lesions, the study showed. 

Oral/topical antibiotics exhibit limited efficacy for non-inflammatory lesions and should not be utilized as stand-alone treatments due to the risk of bacterial resistance.

“Our study provides the most comprehensive evidence to date about common pharmacological interventions for acne vulgaris with analyses of both percentage and absolute reduction in lesion counts and detailed comparisons for each intervention,” the study authors conclude.

The detailed comparisons of each intervention can serve as a practical database and to complement to current guidelines, they note.

The research appears in the Annals of Family Medicine.