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Ivermectin Improves Quality of Life in People With Rosacea
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The effect of topical ivermectin was compared with that of metronidazole on quality of life in patients with rosacea. Quality-of-life scores were significantly higher in the ivermectin group compared with the metronidazole group, with most improvement in reported “anxiety/depression” and “pain/discomfort.”
abstract
This abstract is available on the publisher's site.
Access this abstract nowHealth-Related Quality of Life (HRQoL) is an important outcome to dermatologic diseases such as rosacea; however, the literature has shown that only limited studies have included HRQoL to evaluate treatment outcomes.1 This analysis aims to compare the outcomes of treatments for rosacea by measuring the HRQoL using two patient-reported outcomes (PRO) instruments (DLQI-Dermatology Life Quality Index and EQ-5D) focusing on the long term, as results from the initial 16-week treatment for DLQI have been published elsewhere.2 The EQ-5D is a generic utility measure consisting of five questions and a visual analog scale (VAS).
Rosacea is a tremendously difficult condition to treat satisfactorily. The folks from Galderma describe a statistically significant improvement in quality of life in rosacea patients treated with Soolantra (topical ivermectin 1% cream) vs Metrogel (metronidazole 0.75% gel). It is always difficult to distinguish a statistically significant difference from a clinically meaningful one. I do believe the difference is real, and I have a number of my own metronidazole gel patient failures who are very satisfied with topical ivermectin. I would predict, however, that low-dose isotretinoin would be more effective than both of these topical products for papulopustular rosacea.
Of course, cost weighs into the equation. Excluding the availability of coupons and insurance company deals with the manufacturer, topical ivermectin is at least twice as expensive as topical metronidazole. It is unclear if there would be any cost savings if insurance companies required cycling through metronidazole gel only to arrive at ivermectin cream. It is clear that “stepped therapy” frustrates the dermatologist! That said, if an insurance company or the patient has a significant cost savings, it may well be worth a trial of the cheaper but less effective option before stepping up to the more expensive but more effective option. This is especially true when considering oral isotretinoin, which is considerably more expensive and has considerably more significant side effects.