1
|
Paller AS, Green LJ, Silverberg N, Stripling S, Cartwright M, Enloe C, Wells N, Kowalewski EK, Maeda-Chubachi T. Berdazimer gel for molluscum contagiosum in patients with atopic dermatitis. Pediatr Dermatol 2024; 41:438-444. [PMID: 38413239 DOI: 10.1111/pde.15575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Controlling molluscum contagiosum (MC) infections is critical in atopic dermatitis (AD) management. This post hoc analysis assessed the efficacy and safety of berdazimer gel, 10.3% (topical, antiviral, nitric oxide-releasing medication) versus vehicle in MC patients with or without AD. METHODS Three Phase 3, multicenter, randomized, double-blind, vehicle-controlled, parallel-group trials (B-SIMPLE[berdazimer sodium in molluscum patients with lesions]1, -2, -4) enrolled patients 6 months and older with 3-70 mollusca. Berdazimer or vehicle was applied once daily to all MC lesions for 12 weeks. Data from three Phase 3 studies were integrated for subgroup efficacy and safety assessments using several weighted meta-analysis approaches. Patients with concurrent AD or a history of AD/eczema were categorized as AD+ subgroup (AD- when absent). Primary efficacy endpoint: complete lesion clearance at Week 12. Safety endpoints included adverse events (AEs) through Week 24 and local skin reactions through Week 12. RESULTS Of 1598 enrolled patients, 209 (13.1%) were AD+. Baseline mean lesion counts were greater in AD+ (26.4) than AD- (19.3). Complete clearance rates were higher at Week 12 for berdazimer compared with vehicle in AD+ (n = 209; 35.0% vs. 27.4%; odds ratio [OR], 1.3; 95% CI, 0.7-2.5) and AD- (n = 1389; 29.1% vs. 18.9%; OR 1.8; 95% CI 1.4-2.4) subgroups. AEs in AD+ were application-site pain (21.6% with berdazimer vs. 11.9% with vehicle), dermatitis (12.8% vs. 2.4%), and erythema (9.6% vs. 7.1%). CONCLUSIONS Berdazimer gel showed favorable efficacy regardless of AD status. Berdazimer-induced erythema may be indistinguishable from AD symptoms or with inflammatory response upon resolution of molluscum.
Collapse
Affiliation(s)
- Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine and the Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Lawrence J Green
- Department of Dermatology, George Washington University School of Medicine, Washington, DC, USA
| | - Nanette Silverberg
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephen Stripling
- Pediatric Department, Coastal Pediatric Research, Charleston, South Carolina, USA
| | | | | | | | - Elaine Kearney Kowalewski
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | |
Collapse
|
2
|
Sugarman JL, Hebert A, Browning JC, Paller AS, Stripling S, Green LJ, Cartwright M, Enloe C, Wells N, Maeda-Chubachi T. Berdazimer gel for molluscum contagiosum: An integrated analysis of 3 randomized controlled trials. J Am Acad Dermatol 2024; 90:299-308. [PMID: 37804936 DOI: 10.1016/j.jaad.2023.09.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND An out-of-office therapeutic agent indicated for molluscum contagiosum is needed. OBJECTIVE To assess the efficacy and safety of berdazimer gel, 10.3% (a topical, antiviral, nitric oxide-releasing medication) versus vehicle. METHODS Berdazimer gel, 10.3% or vehicle was applied once daily to all molluscum contagiosum lesions for 12 weeks in patients ≥6 months with 3-70 mollusca. Efficacy assessment: complete lesion clearance and partial clearance at week 12. Safety and tolerability assessment: adverse events through week 24 and local skin reactions through week 12. RESULTS There were 1598 patients enrolled (n = 917 berdazimer, n = 681 vehicle). Berdazimer was superior to vehicle at week 12 in complete clearance rates, 30.0% versus 19.8% (odds ratio, 1.75; 95% CI, 1.38-2.23, P < .001). Subgroup analyses of primary efficacy showed consistent favorable efficacy for berdazimer across most subgroups, including age, sex, baseline lesion count, and disease duration. Berdazimer provided favorable outcome for partial clearance. Application-site pain (18.7% vs 4.8% in berdazimer vs vehicle) and erythema (11.7% vs 1.3%), mostly mild to moderate, were the most common local skin reactions. LIMITATIONS Berdazimer sodium in molluscum patients with lesions (B-SIMPLE) trials enrolled only US patients; no efficacy assessments beyond week 12. CONCLUSIONS Berdazimer gel, 10.3% showed favorable efficacy and safety across subgroups.
Collapse
Affiliation(s)
- Jeffrey L Sugarman
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Adelaide Hebert
- Department of Dermatology, UTHealth McGovern Medical School, Houston, Texas
| | | | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen Stripling
- Pediatric Department, Coastal Pediatric Research, Charleston, South Carolina
| | - Lawrence J Green
- Department of Dermatology, George Washington University School of Medicine, Washington, DC
| | | | | | - Nick Wells
- Syneos Health, Hampshire, United Kingdom
| | | |
Collapse
|
3
|
Pera Calvi I, R Marques I, Cruz SA, Mesquita YLL, Padrao EMH, Souza RM, Brown A, Caçador DGV, Poppe LM, Lopes Almeida Gomes L. Safety and efficacy of topical nitric oxide-releasing berdazimer gel for molluscum contagiosum clearance: A systematic review and meta-analysis of randomized controlled trials. Pediatr Dermatol 2023; 40:1060-1063. [PMID: 37721050 DOI: 10.1111/pde.15419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/05/2023] [Indexed: 09/19/2023]
Abstract
Molluscum contagiosum (MC) is a contagious infection that, although benign, can become an aesthetic burden and lead to other opportunistic infections, secondary dermatitis, and self-isolation. Currently, several treatment options are available for MC, including the newly investigated nitric oxide-releasing berdazimer gel, leading this review to evaluate randomized controlled trials (RCT) comparing berdazimer gel with a vehicle for treating MC. The meta-analysis included three reports and four RCT involving 1854 patients, with 1106 (59.6%) randomized to receive berdazimer. Our findings suggest that berdazimer is effective in the management of MC lesions, but the increased clearance of lesions and reduction of scarring must be weighed against the potential for topical adverse effects, particularly when considering the use of this therapy in pediatric patients.
Collapse
Affiliation(s)
- Izabela Pera Calvi
- Division of Medicine, Immanuel Kant Baltic Federal University, Kaliningrad, Kaliningrad, Russia
| | - Isabela R Marques
- Division of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Sara A Cruz
- Division of Medicine, Immanuel Kant Baltic Federal University, Kaliningrad, Kaliningrad, Russia
| | | | - Eduardo M H Padrao
- Internal Medicine Division, University of Connecticut, Farmington, Connecticut, USA
| | - Rafaela M Souza
- Dermatology Division, La Paz University Hospital, Madrid, Spain
| | - Andrew Brown
- Internal Medicine Division, University of Connecticut, Farmington, Connecticut, USA
| | - Danielle G V Caçador
- Dermatology Division, Institute of Research and Medical Education (IPEMED) Faculty of Medical Sciences, São Paulo, São Paulo, Brazil
| | - Lidia M Poppe
- Dermatology Division, Praxis Dr. Poppe & Kollegen, Bad Kissingen, Bavaria, Germany
| | - Lais Lopes Almeida Gomes
- Dermatology Division, Cutaneous Biology Research Center (CBRC), Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| |
Collapse
|
4
|
Kakleas K, Sinha S, Wilson D, Stiefel G. Lemon Myrtle (Backhousia citriodora): An Alternative and Effective Treatment for Molluscum Contagiosum in Children with Atopic Dermatitis. Chin J Integr Med 2023; 29:1018-1020. [PMID: 37695447 DOI: 10.1007/s11655-023-3747-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Konstantinos Kakleas
- Paediatric Allergy Clinic, Agia Sofia Children's Hospital, Athens, 11527, Greece.
| | - Shilpee Sinha
- Paediatric Allergy Clinic, Leicester Royal Infirmary Hospital, Leicester, LE1 5WW, UK
| | - Deborah Wilson
- Paediatric Allergy Clinic, Leicester Royal Infirmary Hospital, Leicester, LE1 5WW, UK
| | - Gary Stiefel
- Paediatric Allergy Clinic, Leicester Royal Infirmary Hospital, Leicester, LE1 5WW, UK
| |
Collapse
|
5
|
Lacarrubba F, Micali G, Trecarichi AC, Quattrocchi E, Monfrecola G, Verzì AE. New Developing Treatments for Molluscum Contagiosum. Dermatol Ther (Heidelb) 2022; 12:2669-2678. [PMID: 36239905 PMCID: PMC9674806 DOI: 10.1007/s13555-022-00826-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
A large variety of treatments for molluscum contagiosum (MC) are available, but none are Food and Drug Administration (FDA) approved and there is no consensus on the optimal approach, mainly owing to a lack of high-level data. Physical modalities are widely used, but require repeated outpatient visits for administration, are painful and difficult to perform in children, and are associated with the possibility of residual scarring and post-inflammatory hypo- or hyperpigmentation. Two experimental topical drugs, a new standardized preparation of topical cantharidin, called VP-102, and a topical nitric oxide (NO)-releasing product containing berdazimer, called SB206, represent promising products that have been designed to overcome the limitations of current treatments. They have recently shown good results in terms of safety and efficacy in large cohorts of patients in phase III studies and have the potential to be the first FDA-approved therapies for the treatment of MC.
Collapse
Affiliation(s)
- Francesco Lacarrubba
- Dermatology Clinic, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
| | - Giuseppe Micali
- Dermatology Clinic, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | | | | | - Giuseppe Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anna Elisa Verzì
- Dermatology Clinic, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| |
Collapse
|
6
|
Browning JC, Enloe C, Cartwright M, Hebert A, Paller AS, Hebert D, Kowalewski EK, Maeda-Chubachi T. Efficacy and Safety of Topical Nitric Oxide-Releasing Berdazimer Gel in Patients With Molluscum Contagiosum: A Phase 3 Randomized Clinical Trial. JAMA Dermatol 2022; 158:871-878. [PMID: 35830173 PMCID: PMC9280611 DOI: 10.1001/jamadermatol.2022.2721] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Molluscum contagiosum (MC) is a highly contagious skin condition. Lesions may persist for months to years, and no US Food and Drug Administration-approved medications are currently available in the US. Objective To assess the efficacy and safety of berdazimer gel, 10.3%, a novel topical nitric oxide-releasing medication, in the treatment of MC. Design, Setting, and Participants This was a multicenter, vehicle-controlled, double-blind, phase 3 randomized clinical trial (B-SIMPLE4) conducted in 55 clinics (mostly dermatology and pediatric) in the US from September 1, 2020, to July 21, 2021. Eligible participants were 6 months or older and had from 3 to 70 raised MC lesions. Patients with sexually transmitted MC or with MC only in the periocular area were excluded. Interventions Patients were randomized to treatment with berdazimer gel, 10.3%, or vehicle gel, applied as a thin layer to all lesions once daily for 12 weeks. Main Outcomes and Measures The primary efficacy end point was complete clearance of all MC lesions at week 12. Safety and tolerability measures included adverse event frequency and severity, and assessment of local skin reactions and scarring. Data analyses were performed from August 31, 2021, to September 14, 2021. Results A total of 891 participants were randomized, 444 to berdazimer, 10.3% (mean [range] age, 6.6 [0.9-47.5] years; 228 [51.4%] male; 387 [87.2%] White individuals), and 447 to vehicle (mean [range] age, 6.5 [1.3-49.0] years; 234 [52.3%] female; 382 [85.5%] White individuals). In the intention-to-treat population, 88.5% (393 patients) in the berdazimer group and 88.8% (397 patients) in the vehicle group had a lesion count performed at week 12. At week 12, 32.4% (144 patients) in the berdazimer group achieved complete clearance of MC lesions compared with 19.7% (88 patients) in the vehicle group (absolute difference, 12.7%; odds ratio, 2.0; 95% CI, 1.5-2.8; P < .001) with 14.4% (64 patients) of the berdazimer group discontinuing treatment because of MC clearance compared with 8.9% (40 patients) of the vehicle group. Adverse event rates were low. The most common adverse events were application-site pain and erythema, mostly mild in severity. Adverse events leading to discontinuation affected 4.1% (18 patients) of the berdazimer group and 0.7% (3 patients) of the vehicle group. The most common local skin reaction was mild to moderate erythema. Conclusions and Relevance Use of berdazimer gel, 10.3%, for MC appears to demonstrate favorable efficacy and safety with low adverse event rates. Trial Registration ClinicalTrials.gov Identifier: NCT04535531.
Collapse
Affiliation(s)
| | | | | | - Adelaide Hebert
- University of Texas Health McGovern Medical School, Houston, Texas
| | - Amy S Paller
- The Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - David Hebert
- Novan Inc, Durham, North Carolina.,Radius Health Inc, Boston, Massachusetts
| | | | | |
Collapse
|
7
|
Ugarte S, Mehrmal S, Knopf K. Chemotherapy with paclitaxel for recalcitrant molluscum contagiosum in an HIV-infected patient. BMJ Case Rep 2021; 14:14/6/e240776. [PMID: 34112632 DOI: 10.1136/bcr-2020-240776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Molluscum contagiosum (MC) is a viral skin infection seen in children, sexually active adults and immunocompromised populations. It is usually a self-limiting illness that typically spontaneously resolves without therapeutic intervention. However, when the papules are extensive or refractory causing complications or aesthetic issues, multiple treatment modalities exist to relieve symptoms, limit spread and decrease the social stigma associated with visible lesions. Treatment is especially important in HIV/AIDS infected populations, where prevalence is estimated between 5% and 18% and susceptibility to larger, widespread and recalcitrant lesions involving atypical distributions is more common. We evaluated a 38-year-old woman with a history of AIDS (CD4+ T cell count <25 cells/µL) and poor adherence with antiretroviral therapy who presented with a 9-month history of persistent, progressively worsening facial and truncal umbilicated papules consistent with recalcitrant MC refractory to cidofovir injections. She was successfully treated with paclitaxel with complete resolution of the lesions after four cycles without adverse effects.
Collapse
Affiliation(s)
- Shannon Ugarte
- Oncology, Highland Hospital w UCSF affiliation, Oakland, California, USA
| | - Sino Mehrmal
- Oncology, Highland Hospital w UCSF affiliation, Oakland, California, USA
| | - Kevin Knopf
- Oncology, Highland Hospital w UCSF affiliation, Oakland, California, USA
| |
Collapse
|
8
|
Sivaraj V, Ahamed A, Gurung M, Menon-Johansson AS. Anogenital molluscum contagiosum: treatment choices. Sex Transm Infect 2021; 98:230. [PMID: 34039743 DOI: 10.1136/sextrans-2021-055108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/09/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Azraan Ahamed
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Momta Gurung
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | |
Collapse
|
9
|
Martínez Pallás I, Prieto Torres L, Ara Martín M. [Multiple cutaneous nodules in a pregnant patient]. Semergen 2020; 46:e62-e63. [PMID: 32527688 DOI: 10.1016/j.semerg.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/03/2020] [Indexed: 11/25/2022]
Affiliation(s)
- I Martínez Pallás
- Servicio de Dermatología, Hospital Clínico Lozano Blesa, Zaragoza, España.
| | - L Prieto Torres
- Servicio de Dermatología, Hospital Clínico Lozano Blesa, Zaragoza, España
| | - M Ara Martín
- Servicio de Dermatología, Hospital Clínico Lozano Blesa, Zaragoza, España
| |
Collapse
|
10
|
Meza-Romero R, Navarrete-Dechent C, Downey C. Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clin Cosmet Investig Dermatol 2019; 12:373-381. [PMID: 31239742 PMCID: PMC6553952 DOI: 10.2147/ccid.s187224] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/07/2019] [Indexed: 12/20/2022]
Abstract
Molluscum contagiosum (MC) is a self-limited infectious dermatosis, frequent in pediatric population, sexually active adults, and immunocompromised individuals. It is caused by molluscum contagiosum virus (MCV) which is a virus of the Poxviridae family. MCV is transmitted mainly by direct contact with infected skin, which can be sexual, non-sexual, or autoinoculation. Clinically, MC presents as firm rounded papules, pink or skin-colored, with a shiny and umbilicated surface. The duration of the lesions is variable, but in most cases, they are self-limited in a period of 6-9 months. The skin lesions may vary in size, shape, and location, which is more frequent in immunosuppressed patients, and could present complications such as eczema and bacterial superinfection. The diagnosis is based on clinical findings. A useful clinical tool is dermoscopy. If the diagnostic doubt persists, confocal microscopy or skin biopsy could be performed. The need for active treatment for MC is controversial; however, there is a consensus that it should be indicated in cases of extensive disease, associated with complications or aesthetic complaints. There are several treatment modalities which include mechanical, chemical, immunomodulatory, and antivirals. The objective of this article is to review the current evidence in etiology, clinical manifestations, diagnosis, and management alternatives of MC.
Collapse
Affiliation(s)
- Rodrigo Meza-Romero
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristián Navarrete-Dechent
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Camila Downey
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|