Among women with acne, spironolactone was as effective as oral tetracycline-class antibiotics, according to research published in the Journal of Drugs and Dermatology.
“Long-term oral antibiotic use in acne may be associated with a variety of adverse effects including antibiotic resistance, pharyngitis, inflammatory bowel disease and breast and colon cancer,” John S. Barbieri, MD, MBA, from the University of Pennsylvania Perelman School of Medicine, and colleagues wrote. “Spironolactone may represent an effective and safe alternative to oral antibiotics for women with moderate to severe acne, however, comparative studies are lacking.”
From 2010 to 2016, Barbieri and colleagues conducted an analysis to determine how often women with acne using spironolactone switched to another systemic agent within the first year of treatment compared with those using an oral tetracycline-class antibiotic. A total of 6,684 women used spironolactone to manage their acne, whereas 31,614 were treated with an antibiotic. The researchers controlled for age, topical retinoid and oral contraceptive use.
Overall, 14.4% of the women who were prescribed spironolactone and 13.4% of the women who were prescribed an antibiotic switched to a different agent within a year. Compared with the antibiotics group, the odds ratio for switching to a new agent within a year was 1.07 (95% CI, 0.99-1.16) for women in the spironolactone group (risk difference = 0.007; 95% CI, –0.002 to 0.017).
The similar rates of switching to alternative treatments suggest that spironolactone and tetracycline-class antibiotics have comparable efficacy even though antibiotics were prescribed five times more often, according to the researchers.
“It’s clear that a safe alternative to oral antibiotics could have a huge benefit, and our data show spironolactone may be that alternative,” Barbieri said in a press release.
“Dermatologists should consider spironolactone first instead of antibiotics when it comes to women with acne,” he said.
“Spironolactone may have a better safety profile than oral antibiotics, which is another factor that makes it such an appealing option,” he added. – by Alaina Tedesco
The authors report no relevant financial disclosures.