The efficacy of adapalene-benzoyl peroxide combination increases with number of acne lesions

Background: There is no direct correlation between acne severity and lesion numbers and patients with moderate acne may present with varying lesion counts. The fixed-dose adapalene 0.1%-benzoyl peroxide (BPO) 2.5% combination gel is an efficacious and safe acne treatment. Objective: We sought to evaluate whether the benefit of adapalene-BPO relative to vehicle varies with baseline lesion counts. Methods: Data were pooled from 3 randomized, double-blind, controlled studies, which compared efficacy in 4 treatment groups (adapalene-BPO, adapalene, BPO, and the gel vehicle). Three lesion count subgroups (Low, Mid, and High) were defined based on the number of total, inflammatory, or noninflammatory lesion at baseline. Efficacy of each treatment and benefit of each treatment relative to vehicle were evaluated on the entire population and in all lesion count subgroups. Safety was assessed by local tolerability score and adverse events. Results: Adapalene-BPO provided significant benefit relative to vehicle and monotherapies on the entire population and in all lesion count subgroups (P < .05). At study end point, the benefit of adapalene-BPO relative to vehicle was greatest in the High subgroup, suggesting that patients with the highest baseline lesion counts contributed the most to the treatment benefit observed in the entire population. This effect was only observed with adapalene-BPO and not with monotherapies. Higher baseline lesion counts did not lead to more related adverse event or worse tolerability score for adapalene-BPO. Limitation: These results were generated from clinical trials. Results in clinical practice could differ. Conclusion: The relative benefit of adapalene-BPO increases with higher lesion counts at baseline. (J Am Acad Dermatol 2011;64:1085-91.)