Minocycline for acne vulgaris: efficacy and safety.
Author(s): Garner SE, Eady A, Bennett C, Newton JN, Thomas K, Popescu CM.
Affiliation(s): Research and Development, National Institute for Health and Clinical Excellence
(NICE), London, UK. Sarah.Garner@nice.org.uk.
Publication date & source: 2012, Cochrane Database Syst Rev. , 8:CD002086
BACKGROUND: Minocycline is an oral antibiotic used for acne vulgaris. Its use has
lessened due to safety concerns (including potentially irreversible
pigmentation), a relatively high cost, and no evidence of any greater benefit
than other acne treatments. A modified-release version of minocycline is being
promoted as having fewer side-effects.
OBJECTIVES: To assess new evidence on the effects of minocycline for acne
vulgaris.
SEARCH METHODS: Searches were updated in the following databases to November
2011: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane
Library, MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also
searched trials registers and checked reference lists for further references to
relevant randomised controlled trials (RCTs).The Cochrane Skin Group's Trials
Search Co-ordinator undertook searches exploring minocycline's adverse effects in
EMBASE and MEDLINE in February 2012.
SELECTION CRITERIA: We selected randomised controlled trials (RCTs) comparing
minocycline, at any dose, to an active or a placebo control, in participants with
inflammatory acne vulgaris. For adverse effects, we selected additional studies
that reported the number of adverse effects and the number of participants
treated.
DATA COLLECTION AND ANALYSIS: Outcome measures used in the trials included lesion
counts, acne grades/severity scores, doctors' and participants' global
assessments, adverse effects, and dropout rates. Two authors independently
assessed the quality of each study. Effect sizes were calculated, and
meta-analyses were undertaken where possible.Sixteen studies met the inclusion
criteria for the review of adverse effects.
MAIN RESULTS: We included 12 new RCTs for this update, giving a total of 39 RCTs
(6013 participants). These additional 12 RCTs have not changed the original
conclusions about the clinical efficacy of minocycline.The identified RCTs were
generally small and poor quality. Meta-analysis was rarely possible because of
the lack of data and different outcome measures and trial durations. Although
minocycline was shown to be an effective treatment for moderate to
moderately-severe acne vulgaris, there was no evidence that it is better than any
of the other commonly-used acne treatments. One company-sponsored RCT found
minocycline to be less effective than combination treatment with topical
erythromycin and zinc. No trials have been conducted using minocycline in those
participants whose acne is resistant to other therapies. Also, there is no
evidence to guide what dose should be used.The adverse effects studies must be
interpreted with caution. The evidence suggests that minocycline is associated
with more severe adverse effects than doxycycline. Minocycline, but not other
tetracyclines, is associated with lupus erythematosus, but the risk is small: 8.8
cases per 100,000 person-years. The risk of autoimmune reactions increases with
duration of use. The evidence does not support the conclusion that the more
expensive extended-release preparation is safer than standard minocycline
preparations.
AUTHORS' CONCLUSIONS: Minocycline is an effective treatment for moderate to
moderately-severe inflammatory acne vulgaris, but there is still no evidence that
it is superior to other commonly-used therapies. This review found no reliable
evidence to justify the reinstatement of its first-line use, even though the
price-differential is less than it was 10 years ago. Concerns remain about its
safety compared to other tetracyclines.
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