Doxycycline 200 mg plus adapalene 0.1%/benzoyl peroxide 2.5% gel (D+A/BPO) is an alternative to isotretinoin in patients intolerant to, or unable or unwilling to take, oral isotretinoin, and is an option for treatment of severe nodular acne, according to a new study. Findings suggest that the combination has a favorable composite efficacy/safety profile compared with isotretinoin.

The study, published in British Journal of Dermatology (171(6):1508–1516), was a multicentre, randomized, controlled, noninferiority investigator-blinded study involving 266 subjects. Epiduo^® (adapalene and benzoyl peroxide) Gel, 0.1%/2.5% plus doxycycline hyclate 200 mg/day,  showed a significantly earlier onset of action in reducing nodules, papules/pustules and total lesions at week 2. ISO was superior in reducing nodules (95·6% vs. 88·7%), papules/pustules (95·2% vs. 79·6%) and total lesions (92·9% vs. 78·2%; all P < 0·01) at week 20. 

Treatment-related, medically relevant adverse events  occurred in half as many D+A/BPO subjects (33 events in 18.0% of subjects vs. 73 in 33.8% of subjects, respectively). D+A/BPO was noninferior to ISO in the intent-to-treat population and per-protocol population, based on the composite efficacy/safety end point.