JAMA dermatology · 2026
Topical Preparations for Moderate to Severe Rosacea Treatment: A Systematic Review and Network Meta-Analysis.
СтатьяСистематический обзорNetwork Meta-AnalysisНазвание и аннотация: Перевод в очереди
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Amstutz Anissa Valentina, Sánchez-Feliciano Abizairie, Dewey Eliza, Biba Ursula, Salloum Lana, Barbieri John S
Аннотация
IMPORTANCE: Comparative efficacy and tolerability of topical therapies for rosacea remain incompletely characterized, particularly for novel agents such as encapsulated benzoyl peroxide.
OBJECTIVE: To compare the efficacy and tolerability of topical treatments for moderate to severe rosacea through a systematic review and network meta-analysis of randomized clinical trials (RCTs).
DATA SOURCES: CENTRAL (Cochrane Central Register of Controlled Trials), MEDLINE via Ovid, Web of Science, and Embase databases were searched from inception through August 6, 2025, and supplemented by manual screening of references.
STUDY SELECTION: RCTs published in English that included adults with moderate to severe rosacea and assessed topical therapies for rosacea were included.
DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed risk of bias using the Cochrane Risk of Bias tool, version 2.0. Data were synthesized using random-effects network meta-analyses. Treatment rankings were estimated using SUCRA (surface under the cumulative ranking) values. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework.
MAIN OUTCOMES AND MEASURES: Prespecified primary outcomes were mean change in absolute lesion count, Investigator Global Assessment (IGA) success, and discontinuation due to adverse events or effects. Secondary outcomes included patient-reported measures and clinician-assessed erythema.
RESULTS: Of 2858 records screened, 32 RCTs met inclusion criteria, comprising a total of 11 399 adults treated with 10 topical interventions. Most studies had a 8- to 16-week follow-up period. Compared with metronidazole, ivermectin and encapsulated benzoyl peroxide demonstrated greater reductions in lesion count (mean difference [MD], 4.17; 95% CI, 1.85-6.48; and MD, 4.14; 95% CI, 0.62-7.66, respectively) and higher likelihood of IGA success (MD, 10.31; 95% CI, 2.85 to 17.77; and MD, 15.51; 95% CI, 2.35-28.68, respectively). Frequency of discontinuation due to adverse events were similar between treatments, although discontinuation was more frequent with encapsulated benzoyl peroxide than metronidazole (MD, 8.33; 95% CI, 0.45-16.22). Limited data precluded robust quantitative synthesis of patient-reported outcomes and erythema outcomes.
CONCLUSIONS AND RELEVANCE: In this systematic review and network meta-analysis, topical ivermectin and encapsulated benzoyl peroxide were more efficacious than metronidazole for rosacea, although encapsulated benzoyl peroxide was also associated with higher discontinuation due to adverse events. Future trials should evaluate long-term efficacy, tolerability, and standardized patient-reported outcomes.
OBJECTIVE: To compare the efficacy and tolerability of topical treatments for moderate to severe rosacea through a systematic review and network meta-analysis of randomized clinical trials (RCTs).
DATA SOURCES: CENTRAL (Cochrane Central Register of Controlled Trials), MEDLINE via Ovid, Web of Science, and Embase databases were searched from inception through August 6, 2025, and supplemented by manual screening of references.
STUDY SELECTION: RCTs published in English that included adults with moderate to severe rosacea and assessed topical therapies for rosacea were included.
DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed risk of bias using the Cochrane Risk of Bias tool, version 2.0. Data were synthesized using random-effects network meta-analyses. Treatment rankings were estimated using SUCRA (surface under the cumulative ranking) values. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework.
MAIN OUTCOMES AND MEASURES: Prespecified primary outcomes were mean change in absolute lesion count, Investigator Global Assessment (IGA) success, and discontinuation due to adverse events or effects. Secondary outcomes included patient-reported measures and clinician-assessed erythema.
RESULTS: Of 2858 records screened, 32 RCTs met inclusion criteria, comprising a total of 11 399 adults treated with 10 topical interventions. Most studies had a 8- to 16-week follow-up period. Compared with metronidazole, ivermectin and encapsulated benzoyl peroxide demonstrated greater reductions in lesion count (mean difference [MD], 4.17; 95% CI, 1.85-6.48; and MD, 4.14; 95% CI, 0.62-7.66, respectively) and higher likelihood of IGA success (MD, 10.31; 95% CI, 2.85 to 17.77; and MD, 15.51; 95% CI, 2.35-28.68, respectively). Frequency of discontinuation due to adverse events were similar between treatments, although discontinuation was more frequent with encapsulated benzoyl peroxide than metronidazole (MD, 8.33; 95% CI, 0.45-16.22). Limited data precluded robust quantitative synthesis of patient-reported outcomes and erythema outcomes.
CONCLUSIONS AND RELEVANCE: In this systematic review and network meta-analysis, topical ivermectin and encapsulated benzoyl peroxide were more efficacious than metronidazole for rosacea, although encapsulated benzoyl peroxide was also associated with higher discontinuation due to adverse events. Future trials should evaluate long-term efficacy, tolerability, and standardized patient-reported outcomes.