TOPLINE

Topical ivermectin and encapsulated benzoyl peroxide provided greater short-term improvements in inflammatory lesion counts and Investigator Global Assessment (IGA) success than metronidazole, the current standard first-line topical therapy, in adults with moderate-to-severe rosacea.

METHODOLOGY

• Researchers conducted a network meta-analysis of 32 randomized clinical trials (RCTs) evaluating 11,399 adults (mean age, 49.4 years) with moderate-to-severe rosacea from inception through August 2025.
• Studies evaluating 10 topical treatments (eg, metronidazole, ivermectin, azelaic acid, minocycline, encapsulated benzoyl peroxide, brimonidine, oxymetazoline, and sulfacetamide) were included. Most studies had an 8- to 16-week follow-up period.
• The primary outcomes were mean change in absolute lesion count, IGA success (defined as a two-grade improvement and clear or almost clear skin), and discontinuation due to adverse events.

TAKEAWAY

• Ivermectin demonstrated greater reductions in lesion count than metronidazole (mean difference [MD], 4.17; 95% CI, 1.85-6.48) and a higher likelihood of IGA success (MD, 10.31 percentage points; 95% CI, 2.85-17.77).
• Encapsulated benzoyl peroxide also showed superior efficacy vs metronidazole for lesion count reduction (MD, 4.14; 95% CI, 0.62-7.66) and IGA success (MD, 15.51 percentage points; 95% CI, 2.35-28.68).
• Discontinuation rates for adverse events were similar between treatments, although encapsulated benzoyl peroxide was associated with a higher adverse event-related discontinuation than metronidazole (MD, 8.33; 95% CI, 0.45-16.22).
• Minocycline and azelaic acid showed no significant differences in lesion count reduction or IGA success vs metronidazole.

IN PRACTICE

“Topical ivermectin and encapsulated benzoyl peroxide demonstrated superior short-term efficacy compared with metronidazole for reducing inflammatory lesion counts and improving global disease severity in patients with moderate-to-severe rosacea,” the study authors concluded. “These findings,” they added, “provide comparative evidence to inform initial topical treatment selection but are limited to short-term outcomes.”

SOURCE

The study was led by Anissa Valentina Amstutz, Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, and was published online on July 1 in JAMA Dermatology.

LIMITATIONS

Limited head-to-head trials between treatments. Potential heterogeneity in trial design or outcome measurement could affect the reliability of indirect estimates. Most trials evaluated outcomes for only 16 weeks or less, limiting assessment of long-term efficacy.

DISCLOSURES

The authors did not disclose funding information. One author disclosed receiving consulting fees from Alosa Health, Galderma, Honeydew Care, Sanofi Pasteur, Sagimet Biosciences, and Twi Biotechnology outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.