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Poteate A, Levy-Hacham O, York JP. Real-World Adverse Events Associated with Encapsulated Benzoyl Peroxide/Tretinoin, 3%/0.1%, and Encapsulated Benzoyl Peroxide, 5. Dermatol Ther (Heidelb) 2024; 14:285-292. [PMID: 38243147 PMCID: PMC10890991 DOI: 10.1007/s13555-023-01095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 01/21/2024] Open
Abstract
Encapsulated benzoyl peroxide, 5%, for rosacea and a combined formulation of encapsulated benzoyl peroxide/tretinoin, 3%/0.1%, for acne vulgaris, utilize microencapsulation, a process by which active pharmaceutical agents are enclosed in inert, permeable silica shells that provide a buffer between the drug and the skin. The silica shells allow a gradual release of the drug while also allowing combinations of active ingredients that would not otherwise be possible. This technology allows benzoyl peroxide and tretinoin to be combined in the same vehicle without risking the benzoyl peroxide-mediated oxidative destruction of tretinoin. In the current study, we queried the Galderma pharmacovigilance database to quantify and categorize adverse events associated with using these products in the USA during a 12-month period from May 2022 through April 2023. The adverse events were generally mild and restricted to local irritation, pruritus, burning sensation, and erythema. The real-world incidence and type of adverse events reported by the community for encapsulated benzoyl peroxide/tretinoin, 3%/0.1%, and benzoyl peroxide, 5%, were consistent with the safety and tolerability findings from the phase III clinical studies of these treatments.
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Affiliation(s)
| | | | - J P York
- Galderma Laboratories LP, Dallas, TX, USA.
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Del Rosso J, Sugarman J, Green L, Lain T, Levy-Hacham O, Mizrahi R, Gold LS. Efficacy and safety of microencapsulated benzoyl peroxide and microencapsulated tretinoin for the treatment of acne vulgaris: Results from two phase 3 double-blind, randomized, vehicle-controlled studies. J Am Acad Dermatol 2023; 89:719-727. [PMID: 37356627 DOI: 10.1016/j.jaad.2023.05.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Benzoyl peroxide and tretinoin are commonly prescribed acne treatments. Historically, they have been difficult to combine in a single formulation due to chemical instability, and both medications are potentially irritating. Microencapsulation helps overcome these challenges. OBJECTIVE Examine efficacy, safety, and tolerability of encapsulated BPO/encapsulated tretinoin (E-BPO/T) cream, 3%/0.1%. METHODS Subjects ≥9 years old with moderate to severe acne were enrolled in 2 multicenter, double-blind, vehicle-controlled, parallel trials and randomized (2:1) to 12 weeks of once-daily E-BPO/T (n = 571) or vehicle cream (n = 287). RESULTS E-BPO/T was significantly superior to vehicle in both studies, with more subjects achieving IGA success with E-BPO/T (38.5%/25.4%) versus vehicle (11.5%/14.7%; P < .001/P = .017). The change from baseline in inflammatory lesion count for E-BPO/T was -21.6 versus -14.8 for vehicle (P < .001) in study 1 and -16.2 versus -14.1 (P = .018) in study 2. The changes from baseline in noninflammatory lesions for E-BPO/T were -29.7 versus -19.8 for vehicle (P < .001) and -24.2 and -17.4 (P < .001) in studies 1 and 2, respectively. E-BPO/T was well tolerated in both studies. LIMITATIONS Long-term data are not available. CONCLUSION E-BPO/T provided statistically significant and clinically relevant improvements in IGA and inflammatory and noninflammatory lesion counts and was well tolerated in subjects with moderate to severe acne.
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Affiliation(s)
- James Del Rosso
- JDR Dermatology Research, Las Vegas, Nevada; Advanced Dermatology and Cosmetic Surgery, Maitland, Florida; Touro University Nevada, Henderson, Nevada.
| | - Jeffrey Sugarman
- University of California-San Francisco, San Francisco, California
| | - Lawrence Green
- Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia
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Bhatia ND, Werschler WP, Baldwin H, Sugarman J, Green LJ, Levy-Hacham O, Nov O, Ram V, Stein Gold L. Efficacy and Safety of Microencapsulated Benzoyl Peroxide Cream, 5%, in Rosacea: Results From Two Phase III, Randomized, Vehicle-Controlled Trials. J Clin Aesthet Dermatol 2023; 16:34-40. [PMID: 37636253 PMCID: PMC10452484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Objective A new formulation of benzoyl peroxide (E-BPO cream, 5%) entraps benzoyl peroxide (BPO) in silica microcapsules. This study assesses the efficacy, safety, and tolerability of E-BPO cream, 5%, in rosacea in two Phase III clinical trials. Methods In two 12-week, randomized, double-blind, vehicle cream-controlled Phase III trials, 733 subjects at least 18 years old with moderate to severe rosacea were randomized (2:1) to once-daily E-BPO cream, 5%, or vehicle. Results In Study 1, the proportion of subjects achieving IGA clear/almost clear at Week 12 was 43.5 percent for E-BPO cream, 5%, and 16.1 percent for vehicle. In Study 2, the respective values were 50.1 percent and 25.9 percent. In Study 1, the decrease in lesion count from baseline to Week 12 was -17.4 for E-BPO cream, 5%, versus -9.5 for vehicle. In Study 2, the respective values were -20.3 and -13.3 (all P<0.001). The difference was also significant at Week 2. There were no treatment-related serious adverse events; 1.4 percent of subjects (1.8% E-BPO cream, 5%, 0.4% vehicle) discontinued due to adverse events. Assessed local tolerability was found to be similar among subjects in both E-BPO and vehicle. E-BPO was not compared with unencapsulated BPO. Conclusion E-BPO is an effective and well tolerated treatment for rosacea. Clinicaltrials.gov Identifiers: NCT03564119, NCT03448939.
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Affiliation(s)
- Neal D Bhatia
- Dr. Bhatia is with Therapeutics Clinical Research in San Diego, California
| | - Wm Philip Werschler
- Dr. Werschler is with the University of Washington and Premier Clinical Research in Spokane, Washington
| | - Hilary Baldwin
- Dr. Baldwin is with the Acne Treatment and Research Center in Brooklyn, New York, and the Rutgers Robert Wood Johnson Medical Center in New Brunswick, New Jersey
| | - Jeffrey Sugarman
- Dr. Sugarman is with the University of California San Francisco in San Francisco, California
| | - Lawrence J Green
- Dr. Green is with the George Washington University School of Medicine in Washington, DC
| | - Ofra Levy-Hacham
- Drs. Levy-Hacham and Nov are with Sol-Gel Technologies in Ness Ziona, Israel. Additionally, Ms. Ram is with Sol-Gel Technologies in Ness Ziona, Israel
| | - Ori Nov
- Drs. Levy-Hacham and Nov are with Sol-Gel Technologies in Ness Ziona, Israel. Additionally, Ms. Ram is with Sol-Gel Technologies in Ness Ziona, Israel
| | - Vered Ram
- Drs. Levy-Hacham and Nov are with Sol-Gel Technologies in Ness Ziona, Israel. Additionally, Ms. Ram is with Sol-Gel Technologies in Ness Ziona, Israel
| | - Linda Stein Gold
- Dr. Stein Gold is with Henry Ford Health Systems in Detroit, Michigan
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Werschler WP, Sugarman J, Bhatia N, Baldwin H, Green LJ, Nov O, Ram V, Levy-Hacham O, Stein Gold L. Long-term Efficacy and Safety of Microencapsulated Benzoyl Peroxide Cream, 5%, in Rosacea: Results From an Extension of Two Phase III, Vehicle-controlled Trials. J Clin Aesthet Dermatol 2023; 16:27-33. [PMID: 37636251 PMCID: PMC10452482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Objective We sought to assess the long-term safety and tolerability of microencapsulated benzoyl peroxide cream, 5% (E-BPO cream, 5%), in subjects with rosacea. Efficacy and tolerability have been previously demonstrated in two 12-week, randomized, double-blind, vehicle-controlled Phase III trials. Methods In this open-label extension study (NCT03564145; clinicaltrials.gov), all subjects from the initial placebo-controlled Phase III trials could receive E-BPO cream, 5%, for up to an additional 40 weeks, up to a total of 52 weeks of E-BPO cream, 5%, exposure. If a subject was assessed at study visits as "clear" or "almost clear" using the 5-point Investigator Global Assessment (IGA) scale (IGA 0 or 1), E-BPO cream, 5%, was not dispensed. If a subject was assessed as "mild to severe" (IGA 2+), E-BPO cream, 5%, was applied daily until they reached "clear" or "almost clear." Results The safety and tolerability profile for E-BPO cream, 5%, was similar to that reported in the Phase III studies. Five subjects (0.9%) discontinued study drug due to treatment-related adverse events, and 17 subjects (3.2%) experienced an adverse event considered related to study drug. IGA success after 40 weeks of active treatment was 66.5 percent for subjects continuing from the Phase III vehicle group (n=172) and 67.6 percent for subjects who continued Phase III E-BPO cream, 5% (n=363). The study ended early in accordance with the protocol. Limitations Safety and tolerability of E-BPO were not compared with those of unencapsulated BPO. Conclusion E-BPO cream, 5%, showed a favorable safety and tolerability profile during this 40-week, open-label extension study.
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Affiliation(s)
- William P. Werschler
- Dr. Werschler is with Spokane Dermatology Clinic and Werschler Aesthetics in Spokane, Washington
| | - Jeffrey Sugarman
- Dr. Sugarman is with the University of California San Francisco School of Medicine in San Francisco, California
| | - Neal Bhatia
- Dr. Bhatia is with Therapeutics Clinical Research in San Diego, California
| | - Hilary Baldwin
- Dr. Baldwin is with the Acne Treatment and Research Center in Brooklyn, New York, and Robert Wood Johnson Medical Center in New Brunswick, New Jersey
| | - Lawrence J. Green
- Dr. Green is with the George Washington University School of Medicine in Washington, DC
| | - Ori Nov
- Dr. Nov, Mr. Ram, and Dr. Levy-Hacham are with Sol-Gel Technologies Ltd in Ness Ziona, Israel
| | - Vered Ram
- Dr. Nov, Mr. Ram, and Dr. Levy-Hacham are with Sol-Gel Technologies Ltd in Ness Ziona, Israel
| | - Ofra Levy-Hacham
- Dr. Nov, Mr. Ram, and Dr. Levy-Hacham are with Sol-Gel Technologies Ltd in Ness Ziona, Israel
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Stein Gold L, Kwong P, Draelos Z, Arekapudi KL, Levy-Hacham O, Erlich M, Desai SR. Impact of Topical Vehicles and Cutaneous Delivery Technologies on Patient Adherence and Treatment Outcomes in Acne and Rosacea. J Clin Aesthet Dermatol 2023; 16:26-34. [PMID: 37288283 PMCID: PMC10243731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective Topical therapies remain the mainstay in treating patients with acne and rosacea. However, emerging real-world evidence demonstrates that desired treatment outcomes might not be achieved if patient satisfaction and adherence are low. Poor tolerability of active drug(s) and vehicle components and/or the drug delivery system could negatively influence adherence. Additionally, adherence might be lower with complex treatment regimens involving the application of multiple topical formulations. Optimizing vehicle tolerability and simplifying regimens that use fixed-dose combinations may improve treatment outcomes, better patient satisfaction, and reduce overall treatment costs. This qualitative review discusses several innovative drug delivery technologies and formulations aimed at improving patient satisfaction and adherence. Methods The authors conducted a search of current and emerging topical drug delivery technologies used in clinical studies, reviewed primary literature on the chemical characteristics of topical dosage forms, and compared the impacts on treatment outcomes for acne and rosacea. Results This article provides insight into innovative vehicles and drug delivery systems that have emerged allowing for fixed-dose combinations of incompatible active drugs and improving the tolerability of historically irritative active ingredients. Limitations Further research is needed to fully highlight the impact of patient satisfaction and modern topical formulations on adherence and treatment outcomes. Conclusion Drug microencapsulation is a delivery technology that has enabled development of a topical fixed-dose combination of benzoyl peroxide and tretinoin preventing the oxidation of tretinoin by benzoyl peroxide and improving the tolerability of the active ingredients.
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Affiliation(s)
- Linda Stein Gold
- Dr. Stein Gold is with the Department of Dermatology at Henry Ford Health System in Detroit, Michigan
| | - Pearl Kwong
- Dr. Kwong is with HCA Healthcare at Mercer University School of Medicine in Orange Park, Florida, and Solutions Through Advanced Research, Inc. in Jacksonville, Florida
| | - Zoe Draelos
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina
| | | | - Ofra Levy-Hacham
- Dr. Levy-Hacham and Ms. Erlich are with Sol-Gel Technologies in Ness Ziona, Israel
| | - Maya Erlich
- Dr. Levy-Hacham and Ms. Erlich are with Sol-Gel Technologies in Ness Ziona, Israel
| | - Seemal R. Desai
- Dr. Levy-Hacham and Ms. Erlich are with Sol-Gel Technologies in Ness Ziona, Israel
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Baldwin H, Elewski B, Hougeir F, Yamauchi P, Levy-Hacham O, Hamil K, Harper J. Sixty Years of Benzoyl Peroxide Use in Dermatology. J Drugs Dermatol 2023; 22:54-59. [PMID: 36607767 DOI: 10.36849/jdd.7150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Benzoyl peroxide (BPO) has been used extensively in industry and health care for more than a century and has been approved for the treatment of acne for over 60 years. Recently, BPO received a second approved indication by the US Food and Drug Administration (FDA) for the treatment of rosacea. Topical BPO use has historically been limited by tolerability, photosensitivity, oxidation, and, uncommonly, contact allergy. Research has led to enhanced efficacy and tolerability, as well as the combination of BPO with other topical medications. These advances have allowed extended use of BPO in additional dermatologic conditions that may not have been feasible in the past. Additionally, the role of BPO in preventing antibiotic resistance cannot be underestimated. Here, we discuss the historical limitations of BPO and recent advances developed to overcome these limitations. We also describe newly approved BPO medications and their role in aiding antibiotic stewardship. J Drugs Dermatol. 2023;22(1):54-59. doi:10.36849/JDD.7150.
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Webster GF, Sugarman J, Levy-Hacham O, Toledano O. Microencapsulated Benzoyl Peroxide and Tretinoin for the Treatment of Acne Vulgaris: Results from a Phase 2 Multicenter, Double-Blind, Randomized, Vehicle-Controlled Study. Skinmed 2020; 18:343-351. [PMID: 33397563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This phase 2, 12-week, multicenter, randomized, double-blind, active- and vehicle-controlled (VC), parallel-group trial assessed the efficacy and safety of silica encapsulated benzoyl peroxide BP (E-BP), two concentrations of silica encapsulated tretinoin (E-ATRA) and their combinations (TWIN high and low) vs VC in 726 males and females ≥9 years of age with moderate-to-severe inflammatory facial acne. The co-primary efficacy endpoints were Investigators Global Assessment (IGA) success rate ("clear" or "almost clear") and changes from baseline in inflammatory and non-inflammatory lesion counts. TWIN high and low were each significantly superior vs VC for IGA success at 12 weeks (39.7% and 27.4%, respectively, vs 12.3%, P < 0.001 and P < 0.01). TWIN high and low resulted in mean reductions in inflammatory lesions of -16.9 (64%) and -17.0 (60.8%) vs -11.5 (42%) for VC. Reductions in non-inflammatory lesions were -23.7 for TWIN low (54.9%) and -23.6 for TWIN high (53.3%) vs -13.7 (32.4%) for VC (all P < 0.001 vs VC). Results for TWIN were also numerically superior to E-BP and E-ATRA. All treatments were safe with comparable skin tolerability. The significant superiority of both combinations over VC and numerical superiority over E-BP and E-ATRA were achieved without an increase in adverse events or reduced skin tolerability.
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Affiliation(s)
- Guy F Webster
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA;
| | - Jeffrey Sugarman
- University of California-San Francisco, School of Medicine San Francisco, CA
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