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Dréno B, Nguyen JM, Hainaut E, Machet L, Leccia MT, Beneton N, Claudel JP, Célérier P, Le Moigne M, Le Naour S, Vrignaud F, Poinas A, Dert C, Boisrobert A, Flet L, Korner S, Khammari A. Efficacy of Spironolactone Compared with Doxycycline in Moderate Acne in Adult Females: Results of the Multicentre, Controlled, Randomized, Double-blind Prospective and Parallel Female Acne Spironolactone vs doxyCycline Efficacy (FASCE) Study. Acta Derm Venereol 2024; 104:adv26002. [PMID: 38380975 PMCID: PMC10910526 DOI: 10.2340/actadv.v104.26002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/28/2023] [Indexed: 02/22/2024] Open
Abstract
Acne in adult females is triggered mainly by hormones. Doxycycline is a reference treatment in acne. Spironolactone targets the androgen receptor of sebaceous glands and is prescribed off-label for female adult acne. This multicentre, controlled, randomized, double-blind prospective and parallel study assessed the efficacy of spironolactone compared with doxycycline in adult female acne. A total of 133 women with moderate acne were randomized to receive treatment with: (i) doxycycline and benzoyl peroxide for 3 months followed by a 3-month treatment with its placebo and benzoyl peroxide, or (ii) spironolactone and benzoyl peroxide for 6 months. Successfully treated patients continued with benzoyl peroxide or spironolactone alone for a further 6 months. Primary endpoints were treatment success at month 4 and month 6 with the AFAST score. At all visits, the ECLA score, lesion counts, local and systemic safety and quality of life were assessed. Spironolactone performed better at month 4 and showed a statistically significant better treatment success after 6 months than doxycycline (p = 0.007). Spironolactone was 1.37-times and 2.87-times more successful compared with doxycycline at respective time-points. AFAST and ECLA scores, as well as lesion counts always improved more with spironolactone. Patients' quality of life was better with spironolactone at month 4 and month 6. Spironolactone was very well tolerated. This is the first study to show that, in female adults with moderate acne, treatment with spironolactone is significantly more successful than doxycycline and very well tolerated.
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Affiliation(s)
- Brigitte Dréno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France.
| | - Jean-Michel Nguyen
- Department of Epidemiology and Biostatistics, CHU Nantes, Nantes, France
| | - Ewa Hainaut
- Department of Dermatology, Poitiers University Hospital, Poitiers, France
| | - Laurent Machet
- Department of Dermatology, CHU Tours, INSERM U1253, University of Tours, Tours, France
| | - Marie-Thérèse Leccia
- Department of Dermatology, Allergology and Photobiology, CHU A. Michallon, Grenoble, France
| | | | | | | | - Marie Le Moigne
- Department of Dermatology, Nantes University, CHU Nantes, CIC1413, Nantes, France
| | - Sarah Le Naour
- Department of Dermatology, Nantes University, CHU Nantes, CIC1413, Nantes, France
| | - Florence Vrignaud
- Clinical Investigation Centre CIC1413, CHU Nantes and INSERM, Nantes, France; Nantes University, CHU Nantes, UTCG, Nantes, France
| | - Alexandra Poinas
- Clinical Investigation Centre CIC1413, CHU Nantes and INSERM, Nantes, France
| | - Cécile Dert
- Health Economics Studies and Development of Health Products, Department of Partnership and Innovation, CHU Nantes, Nantes University, Nantes, France
| | - Aurélie Boisrobert
- Department of Dermatology, Nantes University, CHU Nantes, CIC1413, Nantes, France
| | - Laurent Flet
- Department of Pharmacy, CHU Nantes, Nantes University, Nantes, France
| | - Simon Korner
- Vigilances Unit, Department of Research and Innovation, CHU Nantes, Nantes University, Nantes, France
| | - Amir Khammari
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France; Department of Dermatology, Nantes University, CHU Nantes, CIC1413, Nantes, France
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Poinas A, Lemoigne M, Le Naour S, Nguyen JM, Schirr-Bonnans S, Riche VP, Vrignaud F, Machet L, Claudel JP, Leccia MT, Hainaut E, Beneton N, Dert C, Boisrobert A, Flet L, Chiffoleau A, Corvec S, Khammari A, Dréno B. FASCE, the benefit of spironolactone for treating acne in women: study protocol for a randomized double-blind trial. Trials 2020; 21:571. [PMID: 32586344 PMCID: PMC7318446 DOI: 10.1186/s13063-020-04432-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022] Open
Abstract
Background Acne vulgaris has increased in women over the past 10 years; it currently affects 20–30% of women. The physiopathology of adult female acne is distinguished from that of teenagers essentially by two factors: hormonal and inflammatory. On a therapeutic plan, the four types of systemic treatment approved for female acne include cyclines (leading to bacterial resistance); zinc salts (less effective than cyclines); and antiandrogens (risks of phlebitis). The last alternative is represented by isotretinoin, but its use in women of childbearing potential is discouraged because of the teratogen risks. In this context, spironolactone could represent an interesting alternative. It blocks the 5-alpha-reductase receptors at the sebaceous gland and inhibits luteinizing hormone (LH) production at the pituitary level. It has no isotretinoin constraints and does not lead to bacterial resistance. Currently, very few studies have been performed in a limited number of patients: the studies showed that at low doses (lower than 200 mg/day), spironolactone can be effective against acne. In that context, it is clearly of interest to perform the first double-blind randomized study of spironolactone versus cyclines, which remains the moderate acne reference treatment, and to demonstrate the superiority of spironolactone’s efficacy in order to establish it as an alternative to cyclines. Methods Two hundred female patients will be included. They must have acne vulgaris with at least 10 inflammatory lesions and no more than 3 nodules. After randomization, the patients will be treated by spironolactone or doxycycline for 3 months and after placebo. The study will be blind for the first 6 months and open for the last 6 months. Discussion The treatment frequently used in female acne is systemic antibiotics with many courses, as it is a chronic inflammatory disease. In the context of the recent World Health Organisation (WHO) revelation about the serious, worldwide threat to public health of antibiotic resistance, this trial could give the physician another alternative in the treatment of adult female acne instead of using isotretinoin, which is more complex to manage. Trial registration ClinicalTrials.gov: NCT03334682. Registered on 7 November 2017.
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Affiliation(s)
- Alexandra Poinas
- Clinical Investigation Centre CIC1413, CHU Nantes and INSERM, Nantes, France.
| | - Marie Lemoigne
- Dermatology Department, CHU Nantes, Nantes University, CRCINA, Nantes, France
| | - Sarah Le Naour
- Dermatology Department, CHU Nantes, Nantes University, CRCINA, Nantes, France
| | - Jean-Michel Nguyen
- Department of Epidemiology and Biostatistics, CHU Nantes, Nantes, France
| | - Solène Schirr-Bonnans
- Service Evaluation Economique et Développement des Produits de Santé, Département Partenariats et Innovation, Centre Hospitalier Universitaire de Nantes, Nantes University, Nantes, France
| | - Valery-Pierre Riche
- Service Evaluation Economique et Développement des Produits de Santé, Département Partenariats et Innovation, Centre Hospitalier Universitaire de Nantes, Nantes University, Nantes, France
| | - Florence Vrignaud
- Clinical Investigation Centre CIC1413, CHU Nantes and INSERM, Nantes, France
| | - Laurent Machet
- Department of Dermatology, CHU Tours, INSERM U1253, University of Tours, Tours, France
| | | | - Marie-Thérèse Leccia
- Department of Dermatology, Allergology and Photobiology, CHU A. Michallon, Grenoble, France
| | - Ewa Hainaut
- Service de Dermatologie, Poitiers University Hospital, Poitiers, France
| | | | - Cécile Dert
- Service Evaluation Economique et Développement des Produits de Santé, Département Partenariats et Innovation, Centre Hospitalier Universitaire de Nantes, Nantes University, Nantes, France
| | - Aurélie Boisrobert
- Clinical Investigation Centre CIC1413, CHU Nantes and INSERM, Nantes, France.,Dermatology Department, CHU Nantes, Nantes University, CRCINA, Nantes, France
| | - Laurent Flet
- Department of Pharmacy, CHU Nantes, Nantes, France
| | - Anne Chiffoleau
- Direction de la Recherche, Département Promotion, Cellule Vigilances, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Stéphane Corvec
- CHU Nantes, Service de Bactériologie-Hygiène Hospitalière, CRCINA, INSERM, U1232, Université de Nantes, Nantes, France
| | - Amir Khammari
- Clinical Investigation Centre CIC1413, CHU Nantes and INSERM, Nantes, France.,Dermatology Department, CHU Nantes, Nantes University, CRCINA, Nantes, France
| | - Brigitte Dréno
- Clinical Investigation Centre CIC1413, CHU Nantes and INSERM, Nantes, France.,Dermatology Department, CHU Nantes, Nantes University, CRCINA, Nantes, France
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