The role of brimonidine tartrate gel in the treatment of rosacea

Abstract

Rosacea is a chronic cutaneous condition with a prevalence rate ranging from 9.6% to 22% in recent studies. Facial erythema (transient and permanent) is considered a common denominator that is frequently observed in all subtypes of rosacea and is estimated to affect more than 40 million people worldwide. Brimonidine tartrate is a selective α2-adrenergic receptor agonist and is the first topical treatment approved for facial erythema of rosacea. Clinical trials have demonstrated that brimonidine tartrate provided significantly greater efficacy, compared to vehicle, for the treatment of moderate to severe erythema of rosacea. In addition, brimonidine tartrate has demonstrated a rapid onset of effect, duration of action throughout the day, and good safety profile in studies of up to 1 year. This review critically discusses the role of brimonidine tartrate for the treatment of facial erythema of rosacea by examining both clinical study data and real-world dermatologist experiences across a wide spectrum of treated patients, and concludes that it is a significant therapeutic option in the management of an unmet need of this chronic condition.

Keywords: adverse event; brimonidine tartrate; erythema; rosacea.

Figure 1

Percentage of subjects treated with brimonidine tartrate with improvements on CEA and PSA. Notes: (A) Percentage of subjects having a two-grade improvement on both CEA and PSA on day 29 (treatment with brimonidine tartrate 0.5% versus vehicle gel); P<0.001 versus vehicle over 12 hours. Adapted with permission, from: Fowler J Jr, Jackson M, Moore A, et al. Efficacy and safety of once-daily topical brimonidine tartrate gel 0.5% for the treatment of moder ate to severe facial erythema of rosacea: results of two randomized, double-blind, and vehicle-controlled pivotal studies. J Drugs Dermatol. 2013;12(6):650–656. Copyright © 2013 Journal of Drugs in Dermatology. (B) Percentage of subjects having a one-grade improvement on both CEA and PSA in 30 minutes on day 1 (treatment with brimonidine tartrate 0.5% versus vehicle gel); P<0.001 versus vehicle at all time points. Adapted with permission, from: Jackson JM, Fowler J, Moore A, et al; Brimonidine Phase III Study Group. Improvement in facial erythema within 30 minutes of initial application of brimonidine tartrate in patients with rosacea. J Drugs Dermatol. 2014;13(6):699–704. Copyright © 2014 Journal of Drugs in Dermatology. Abbreviations: n, number; CEA, clinician’s erythema assessment; PSA, patient’s self-assessment.

Figure 2

Standardized photos of a representative subject before and at 30 minutes, 3 hours, 6 hours, 9 hours, and 12 hours after the application of brimonidine tartrate gel on day 1. Notes: ✓ One-grade improvement on both CEA and PSA; ✓✓ two-grade improvement on both CEA and PSA. Abbreviations: CEA, clinician’s erythema assessment; PSA, patient’s self-assessment.

Figure 3

Standardized photos of a representative subject before and at 30 minutes, 3 hours, 6 hours, 9 hours, and 12 hours after the application of brimonidine tartrate gel on day 1. Notes: ✓ One-grade improvement on both CEA and PSA; ✓✓ two-grade improvement on both CEA and PSA. © 2014 European Academy of Dermatology and Venereology. Publisher: John Wiley and Sons. Reproduced from Fowler J, Tan J, Jackson JM, et al; Brimonidine Phase III Study Group. Treatment of facial erythema in patients with rosacea with topical brimonidine tartrate: correlation of patient satisfaction with standard clinical endpoints of improvement of facial erythema. Journal of the European Academy of Dermatology and Venereology. 2015;29(3):474–481. Abbreviations: CEA, clinician’s erythema assessment; PSA, patient’s self-assessment.