Comparative efficacy of clindamycin phosphate with benzoyl peroxide versus clindamycin phosphate with adapalene in acne vulgaris: a systematic review and meta-analysis

Abstract

Acne vulgaris is a common skin condition that significantly impacts both physical appearance and mental well-being. Acne, being a chronic skin condition, often requires continuous treatment. This study aims to evaluate the efficacy and safety of clindamycin phosphate 1.2%/benzoyl peroxide 3% compared to clindamycin phosphate 1.2%/adapalene 0.1% combinations for treating acne vulgaris. A systematic review and meta-analysis of randomized controlled trials were carried out following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and three databases were searched to identify RCTs comparing CLIN/BPO with CLIN/ADAP. Primary outcomes included treatment-emergent adverse events, inflammatory and non-inflammatory lesion counts, and application site side effects. Statistical analyses were conducted using RevMan 5.3. The study included a total of 800 participants across three RCTs. The meta-analysis of three RCTs demonstrated a significantly lower risk of TEAEs with CLIN/BPO (OR = 0.49, 95% CI: 0.35-0.86, p < 0.001). CLIN/BPO also resulted in fewer application site side effects (OR = 0.33, 95% CI: 0.23-0.47, p < 0.001). However, no significant differences were observed between the groups for reducing inflammatory (MD = 1.34, 𝑝 = 0.121) or non-inflammatory lesion counts (MD = 0.04, 𝑝 = 0.98). The study concluded that although CLIN/BPO was associated with fewer side effects, both treatments were equally effective in reducing acne lesions. The favorable safety profile of CLIN/BPO, particularly regarding treatment-emergent and application-site adverse events, suggests it may be the more tolerable option for patients. Future studies with larger, more diverse populations are recommended to confirm these findings and explore long-term efficacy.

Keywords: Acne vulgaris; Benzoyl peroxide; Clindamycin phosphate; Efficacy; Meta-analysis.

Fig. 1

PRISMA flowchart of included studies.

Fig. 2

Risk-bias evaluation results of the included articles.

Fig. 3

Forest chart comparing the OR of TEAEs between CLIN/BPO versus CLIN/ADAP.

Fig. 4

Forest chart comparing the OR of SAEs between CLIN/BPO versus CLIN/ADAP.

Fig. 5

Forest chart comparing the Odds Ratio of AS Side Effects between CLIN/BPO and CLIN/ADAP.

Fig. 6

Analysis of MD of inflammatory lesion count between CLIN/BPO versus CLIN/ADAP.

Fig. 7

Analysis of MD of non-inflammatory lesion count between CLIN/BPO vs. CLIN/ADAP.