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http://www.ncbi.nlm.nih.gov/pubmed/15863861

the NIH research has conclusively shown that there is no discernible benefit to the combination of benzoyl-peroxide and adapalene.

NIH research is published - see J Dermatol. 2005 Mar;32(3):169-73.

Quote: "combination therapy has no superiority over adapalene or benzoyl peroxide alone."

It's another question entirely why we in the US have to pay $290 for this snake-oil mix whereas people in any other country get it for 1/10th of that cost.

Does anyone believe that practicing dermatologists do not read the journal specifically for their profession? There are 2 possible answers and both have bad implications:

a) dermatologist doesn't care to read and keep track of research in their field

b) dermatologist did read the article and doesn't care - prescribes the $290 treatment anyway

Why not ask your dermatologist whether s/he is an a) or a b). Does anyone seriously believe there's an explanation other than a or b ?

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The study was open-labeled, so I wouldn't count that as irrefutable evidence.

I'll see if I can get the full-text somewhere.

Benzoyl peroxide isn't really effective for non-inflammatory acne, so I could see BP + adapalene not working any or much better than adapalene alone. However, for moderate inflammatory acne, BP + adapalene would work, and probably have a faster onset than either alone.

Edited by Michelle Reece

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Several other studies can be easily found that provide results contradictory to the one you mention.

However, I do tend to agree that these combinations have not been shown to be as effective as the dermatological community thought they would be (good in theory - not as good in reality). It is also true that the success rate of most topicals is much lower than we are led to believe by the medical community. In researching your comments, I found this is another study (from the journal of the american academy of dermatology, 2007)

"For success rate, defined as the percentage of patients with “clear” or “almost clear” ratings on the IGA, the adapalene-BPO combination (27.5%) was superior to adapalene (15.5%, P = .008), BPO (15.4%, P = .003), and the vehicle (9.9%, P = .002) at end point (ITT population, week 12, LOCF). Success rate results among the treatment groups began to diverge early in favor of adapalene-BPO and continued to separate throughout the course of the study"

So, in this study, the combo fares better, but note that only 28%ish of people cleared up. Ergo, 72% of people were left mostly horribly disappointed. Most studies on topical treatments show similar results.

You never know if you're going to be one of those people that finds success with these sorts of treatments until you try them, but I do think we should all go into it with more reasonable expectations.

On the point that derms who prescribe these "don't care" - I totally disagree. Firstly there are plenty of peer-reviewed studies that contradict the ONE that you posted. Secondly, derms don't go by studies alone, they also go by experience. My derm fully admitted (when she prescribed me one of these) that the research is inconsistent, but said that it has been her EXPERIENCE that people in similar situations to mine have had success. So, just because someone prescribes these doesn't make them inconsiderate or not well read. I would be more concerned if they read ONE study and based all their opinions on that.

Just sayin.

Edited by Kim28

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perhaps not irrefutable, but note one very important difference: research done by the NIH. NIH is impartial - more so than research that is funded directly or indirectly by big pharma.

Key point I posed that was not addressed in your reply: the cost in USA. Note that you can buy generic adapalene plus Zapzit benzoyl peroxide, mix them and get the same effect (whatever it may be) for about 1/10th the cost.

About your closing remark "probably have a fast onset than either alone"

what is the basis for this statement? Why 'probably have a fast[er] onset than either alone' ?

The study was open-labeled, so I wouldn't count that as irrefutable evidence.

I'll see if I can get the full-text somewhere.

Benzoyl peroxide isn't really effective for non-inflammatory acne, so I could see BP + adapalene not working any or much better than adapalene alone. However, for moderate inflammatory acne, BP + adapalene would work, and probably have a fast onset than either alone.

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I didn't characterize all derms are "don't care". The hypothesis is crystal-clear: they've read it, or they haven't (is there a 3rd option here?)

If they've read it it behooves them to accept the fact that it's at least in question that there's a benefit and to act and advise accordingly. If they don't, then I get to ask whether they care.

When you can get the precise effect by purchasing separately generic adapalene and OTC BO rather than paying the criminally high price of $290 per month for pre-mixed, I have my doubts about whether the derm has my daughter's best interests at heart, or is blind to the fact that $290 is a LOT OF MONEY to some people.

>>Secondly, derms don't go by studies alone, they also go by experience.

Really? Are you basing this on your personal experience, or do you have research? If it's based on your experience, we should disclose to anyone else who reads this thread that you have been treated by _____ (fill in number here, please), and there are about 9600 dermatologists in the USA

(http://www.harriswilliams.com/sites/default/files/industry_reports/dermatology_industry_presentation_aug2013.pdf)

Then we can all consider how applicable your personal assessment of the modus operandi of derms is to the US at large.

Overall your attitude seems to be that since I have quoted only one study my questioning is somehow less valid; you have no problem correcting me on the basis of just one person's (yours) experience and assessment of how dermatologists operate. Doesn't make sense.

The entire point of studies is ***accumulation and sharing of experience***. It would be fitting for doctors to give more weight to studies than personal experience because the studies are intensive, spread over a long time and are scientific and controlled. It's a fact that pharma pumps very large amounts of money to doctors and one has to wonder why (I have my suspicions, since a $290 prescription can be achieved with a generic adapalene and a bottle of OTC BO Zapzit cream

Several other studies can be easily found that provide results contradictory to the one you mention.

However, I do tend to agree that these combinations have not been shown to be as effective as the dermatological community thought they would be (good in theory - not as good in reality). It is also true that the success rate of most topicals is much lower than we are led to believe by the medical community. In researching your comments, I found this is another study (from the journal of the american academy of dermatology, 2007)

"For success rate, defined as the percentage of patients with “clear” or “almost clear” ratings on the IGA, the adapalene-BPO combination (27.5%) was superior to adapalene (15.5%, P = .008), BPO (15.4%, P = .003), and the vehicle (9.9%, P = .002) at end point (ITT population, week 12, LOCF). Success rate results among the treatment groups began to diverge early in favor of adapalene-BPO and continued to separate throughout the course of the study"

So, in this study, the combo fares better, but note that only 28%ish of people cleared up. Ergo, 72% of people were left mostly horribly disappointed. Most studies on topical treatments show similar results.

You never know if you're going to be one of those people that finds success with these sorts of treatments until you try them, but I do think we should all go into it with more reasonable expectations.

On the point that derms who prescribe these "don't care" - I totally disagree. Firstly there are plenty of peer-reviewed studies that contradict the ONE that you posted. Secondly, derms don't go by studies alone, they also go by experience. My derm fully admitted (when she prescribed me one of these) that the research is inconsistent, but said that it has been her EXPERIENCE that people in similar situations to mine have had success. So, just because someone prescribes these doesn't make them inconsiderate or not well read. I would be more concerned if they read ONE study and based all their opinions on that.

Just sayin.

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perhaps not irrefutable, but note one very important difference: research done by the NIH. NIH is impartial - more so than research that is funded directly or indirectly by big pharma.

Key point I posed that was not addressed in your reply: the cost in USA. Note that you can buy generic adapalene plus Zapzit benzoyl peroxide, mix them and get the same effect (whatever it may be) for about 1/10th the cost.

About your closing remark "probably have a fast onset than either alone"

what is the basis for this statement? Why 'probably have a fast[er] onset than either alone' ?

The study was open-labeled, so I wouldn't count that as irrefutable evidence.

I'll see if I can get the full-text somewhere.

Benzoyl peroxide isn't really effective for non-inflammatory acne, so I could see BP + adapalene not working any or much better than adapalene alone. However, for moderate inflammatory acne, BP + adapalene would work, and probably have a fast onset than either alone.

Whoops, typo. I'll fix that.

But what I mean is that a combo therapy could reduce acne earlier (in the trial) than that one ingredient alone.

For example, Topical A reduced acne by 50% at week 4 compared to Topical B reducing acne by 33% at the same week. However, that doesn't mean that Topical A means it's automatically superior in every way to Topical B. At the end of the trial, they could've reduced acne by the same percentage--let's say 66%. They're equivalent for the final results; it's just that Topical A has a faster onset. I've seen a few trials show something like this with other therapies. (IIRC correctly, I came across a BP combo vs BP monotherapy. Need to check my bookmarks.)

You could be right that OTC BP would do. I don't know, because Epiduo could be formulated to enhance maximum penetration and increase compliance. You can only use so many formulations OTC because of laws and others have patented the most effective formulations. An ingredients list of Epiduo can give me some idea, but they may have encapsulated the BP which wouldn't show up on the list.

You do have a point about source of funding. However, I wouldn't quite count as NIH as being "less biased" than any other source. Government (supposedly) has to operate on a tight budget, and government funding doesn't guarantee higher standards. That's why one must delve into the study itself to determine quality.

Edit: Pharma companies do have a large pool of resources. Government can, but there are politics involved (as always). There are benefits and tradeoffs to each funding source.

Edited by Michelle Reece

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I am sorry you are feeling so frustrated, original poster.

Like Michelle, I also do not agree that NIH studies are necessarily more accurate. There are so many factors to consider when evaluating the worth of a study, and I'm not going to go into my justifications, as I have complete faith in the fact that I am well-read in this area, and relatively impartial.

I'm sorry if I upset you by being displeased with a post that quoted one study and made pretty extreme claims. There is a lot of fear mongering that happens on this site, and I don't think it is necessary to approach a (perfectly good) topic like this with inflammatory language such as "bogus" and "doesn't care".

Your bit about my point about experience made very little sense to me. I did not mean to imply that experience is a substitute for research, but that it can sometimes give a greater context of understanding. Patients are individuals, not research stats. You might not like that comment either, but I do!

I agree with Michelle that you might get as good results with your own personal mix, but that these topicals are designed to maintain the integrity of the ingredients in ways that cannot be easily replicated in your bathroom.

And, in regards to your question about the cost of the meds: big pharma companies are terrible, but so are most other large, for-profit institutions. That's just capitalism, and there are some places you can go if you don't like it. Personally I have never paid anywhere near that for any prescription, but the fact that I am not American is a big factor in that.

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