Friday, August 29, 2014
Should You Consider This? Why I think it's a Mistake to consider OCP for acne treatment
Just out is a report on JAAD titled:
Here's the abstract, with my concerns below it:
Both antibiotics and oral contraceptive pills (OCPs) have been found to be effective in managing acne vulgaris. Despite widespread use, few direct comparisons of efficacy between the 2 modalities have been published.
We compared the efficacy of antibiotics and OCPs in managing acne.
A meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane collaboration guidelines.
A review of 226 publications yielded 32 randomized controlled trials that met our inclusion criteria. At 3 and 6 months, compared with placebo, both antibiotics and OCPs effected greater percent reduction in inflammatory, noninflammatory, and total lesions; the 2 modalities at each time point demonstrated statistical parity, except that antibiotics were superior to OCPs in percent reduction of total lesions at 3 months (weighted mean inflammatory lesion reduction: 3-month course of oral antibiotic treatment = 53.2%, 3-month course of OCPs = 35.6%, 3-month course of placebo treatment = 26.4%, 6-month course of oral antibiotic treatment = 57.9%, 6-month course of OCPs = 61.9%, 6-month course of placebo treatment = 34.2%; weighted mean noninflammatory lesion reduction: 3-month course of oral antibiotic treatment = 41.9%, 3-month course of OCPs = 32.6%, 3-month course of placebo treatment = 17.1%, 6-month course of oral antibiotic treatment = 56.4%, 6-month course of OCPs = 49.1%, 6-month course of placebo treatment = 23.4%; weighted mean total lesion reduction: 3-month course of oral antibiotic treatment = 48.0%, 3-month course of OCPs = 37.3%, 3-month course of placebo treatment = 24.5%, 6-month course of oral antibiotic treatment = 52.8%, 6-month course of OCPs = 55.0%, 6-month course of placebo treatment = 28.6%).
Investigative treatment heterogeneity and publication bias are limitations.
Although antibiotics may be superior at 3 months, OCPs are equivalent to antibiotics at 6 months in reducing acne lesions and, thus, may be a better first-line alternative to systemic antibiotics for long-term acne management in women.
My concerns: In the Yaz litigation, Plaintiffs in claims over Yaz and Yasmin include allegations that the drugs were marketed and advertised in a way that exaggerated benefits such as acne reduction and downplayed serious dangers associated with the drug. Unfortunately, a client of ours who was prescribed the product to help with acne ended up (she alleges) with blood clots and DVT's that were so severe she had to endure multiple surgeries. I know and appreciate that this is just one instance of what she claimed was a horrible result, take the time to read what OCP's side effects are.