Low-Dose Minocycline Bests Doxycycline as Rosacea Rx

TOPLINE:

A low-dose (40 mg) modified formulation of minocycline hydrochloride (DFD-29) was better tolerated and more effective than doxycycline and placebo in patients with moderate to severe papulopustular rosacea.

METHODOLOGY:

• Double-blind phase 3 trials of 653 patients with moderate to severe papulopustular rosacea in MVOR-1 (n = 323; mean age, 47.2 years) or MVOR-2 (n = 330; mean age, 51.6 years).
• Participants were randomly assigned in a 3:3:2 ratio to 40 mg oral minocycline, 40 mg doxycycline, or placebo once daily for 16 weeks.
• Primary outcomes were achieving Investigator’s Global Assessment treatment success and reduction in the total inflammatory lesion count at week 16 with minocycline vs placebo.
• Secondary outcomes included comparisons between minocycline and placebo for achieving at least a 2-grade reduction in Clinician’s Erythema Assessment (CEA) scores from baseline to week 16.

TAKEAWAY:

• Minocycline outperformed placebo and doxycycline with between-group differences, respectively, of 32.9% in MVOR-1 and 34.1% in MVOR-2 (P < .001) and 18.0% in MVOR-1 and 28.3% in MVOR-2 (P < .001).
• Minocycline reduced total inflammatory lesion counts more than placebo and doxycycline in both MVOR-1 and MVOR-2 trials.
• At week 16, more minocycline recipients had at least a 2-grade reduction in the CEA score from baseline vs placebo in MVOR-1 (31.7% vs 13.8%; P = .006) and MVOR-2 (24.5% vs 12.0%; P = .02).
• Adverse events were comparable across groups in each trial, with nasopharyngitis and COVID-19 being the most common.

IN PRACTICE:

“The results of these placebo-controlled randomized clinical trials demonstrate that minocycline is efficacious and provides significantly superior outcomes in rosacea compared with placebo and doxycycline with comparable AEs [adverse events]. These results indicate that minocycline 40 mg may be an appropriate treatment option for the systemic treatment of rosacea,” the authors concluded.

SOURCE:

This study was led by Neal Bhatia, MD, Therapeutics Clinical Research, San Diego. It was published online on March 5, 2025, in JAMA Dermatology.

LIMITATIONS:

The study population included a limited proportion of participants with darker skin, which potentially affected the generalizability of the results. Additionally, participants were instructed to avoid known triggers of rosacea during the trial period, which could have influenced the observed frequency of symptom flare-ups.

DISCLOSURES:

Journey Medical Corporation and Dr Reddy’s Laboratories supported the trials. Bhatia reported receiving grants from Journey during the conduct of the study and personal fees from Journey outside the submitted work. Several authors reported having ties to various sources of financial support.

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