Thinking About Topicals: A Comparison of Clascoterone, Trifarotene, and Tazarotene.

Original Article: Comparison of the Efficacy of Clascoterone, Trifarotene, and Tazarotene for the Treatment of Acne: A Systematic Literature Review and Meta-Analysis

What are the key takeaways of this article?

Acne vulgaris is a very common chronic condition associated with a significant physical and psychological burden on patients. Fortunately, there are a wide variety of treatment options available for the management of acne and new options are constantly being released.

Recently, several topical treatments have become available, including retinoids trifarotene 0.005% cream (Aklief) and tazarotene 0.045% lotion (Arazlo), as well as the anti-androgen clascoterone 1% cream (Winlevi). Trifarotene and tazarotene, as retinoids, modulate cellular differentiation, keratinization, and inflammation within the skin. In contrast, clascoterone competes with dihydrotestosterone in binding to androgen receptors, preventing sebum production. With all three topicals becoming available within the past three years, a pertinent question arises: how do they measure up against one another?

This question is addressed in a study by Shergill et al. where the authors assessed 6 phase 3 randomized control trials (RCTs) in this meta-analysis. To be included in the study, RCTs must have reported the mean percentage change in inflammatory lesions at week 12, the mean percentage change in non-inflammatory lesions at week 12, and the percentage of patients with moderate to severe acne who achieved treatment success (defined using the Investigator’s Global Assessment scale or Evaluator's Global Severity Score).

The authors ultimately found differences for all efficacy endpoints favoring the interventions compared to placebo vehicle groups, as expected. In contrast, when comparing all of the interventions to each other, no significant differences were found in any of the efficacy endpoints. For inflammatory lesions, the mean differences of clascoterone, trifarotene, and tazarotene were -12.8, -11.2, -10.1 (P=0.82) respectively . For non-inflammatory lesions, it was -11.6, -13.9, and -12.8 (P=0.81) respectively. When looking at the rate of treatment success at week 12, there was also no difference in the odds ratio for the interventions at 2.9, 1.9, and 2.1 (P=0.16) respectively.

In this analysis, the main focus was efficacy outcomes without assessing any possible differences in safety or adverse events between treatments. This is a limitation of the study as, besides efficacy, safety is an important consideration when choosing a treatment option.

In conclusion, no significant differences in efficacy were found between clascoterone, trifarotene, and tazarotene for reductions in lesions or treatment success. This finding is very noteworthy for prescribers deciding which option they may want to choose for their patients with acne. It remains essential, nonetheless, to consider other factors and work closely with patients prior to starting any new medications.

Publication Date: July 31st, 2024

Reference: Shergill M, Ali MU, Abu-Hilal M. Comparison of the Efficacy of Clascoterone, Trifarotene, and Tazarotene for the Treatment of Acne: A Systematic Literature Review and Meta-Analysis. Dermatol Ther (Heidelb). 2024;14(5):1093-1102. doi:10.1007/s13555-024-01175-3

Summary By: Taylor Skinner