For Acne, Adapalene Plus Benzoyl Peroxide More Effective Than Either Alone

Conceptual of problems on woman skin.
A network meta-analysis was employed to determine the most effective and best tolerated topical treatments for acne.

Adapalene plus benzoyl peroxide maybe the most effective combination treatment for mild to moderate acne vulgaris compared with topical formulations that contain only antibiotics, yet the former approach is also associated with a slightly higher incidence of adverse events (AEs), according to findings from a meta-analysis published in the British Journal of Dermatology.

A team of international researchers conducted a systematic review and meta-analysis that included 40 clinical trials featuring a pooled cohort of 18,089 participants with mild or moderate acne. The primary outcomes included self-reported improvements in acne and study withdrawal due to AEs.

A total of 11 trials reported assessments based on the Patient Global Assessment of Improvement. In a pooled network analysis, benzoyl peroxide was more effective than vehicle for the improvement of self-reported acne (35% vs 26%, respectively; odds ratio [OR], 1.93; 95% CI, 1.45-2.56).

A combination of benzoyl peroxide and adapalene was also associated with significantly higher rates of improvement in self-reported acne compared with benzoyl peroxide monotherapy (54% vs 35%, respectively; OR, 1.88; 95% CI, 1.32-2.67). A benzoyl peroxide and clindamycin dual regimen was also more effective than benzoyl peroxide alone (49% vs 35%; OR, 1.54; 95% CI, 1.14-2.08).

Overall, withdrawal from these studies due to AEs was generally low. In 35 trials, withdrawal rates were 2.5% for benzoyl peroxide plus adapalene, 2.7% for benzoyl peroxide plus clindamycin, 1.6% for benzoyl peroxide, and 1.0% for adapalene monotherapy.

Limitations of this analysis, according to the investigators, were the inconsistent reporting of trial outcomes, as well as the identification of only 11 trials that included patient-reported efficacy rates.

The researchers wrote that clinicians will need to discuss these findings with patients because” although withdrawal due to AEs was uncommon, adapalene [plus benzoyl peroxide] also appeared to have a slightly higher odds of” self-improved acne.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Stuart B, Maund E, Wilcox C, et al. Topical preparations for the treatment of mild to moderate acne vulgaris: systematic review and network meta-analysis. Br J Dermatol.  Published online April 7, 2021. doi:10.1111/bjd.20080