Hilary Baldwin, MD, medical director, Acne Treatment and Research Center, explains the microencapsulation technology in Twyneo cream and what research went into its development.
Hilary Baldwin, MD, medical director, Acne Treatment and Research Center, explains the microencapsulation technology in Twyneo cream and what research went into its development. Galderma announced the launch of the tretinoin .1% benzoyl peroxide 3% cream at the American Academy of Dermatology Annual Meeting, March 25-29, 2022, in Boston, Massachusetts.
Can you explain what Twyneo cream is, and what makes it different from current facial acne treatments?
Twyneo is a brand new combination of 3% benzoyl peroxide and .1% tretinoin, and we remember that .1% tretinoin is the strongest of the tretinoins that we have. Now you might say, what's new about that? Tretinoin is 50 years old, benzoyl peroxide is 60 years old. You can call them old, or you can call them tried and true. We wouldn't still be using them if they weren't good medications. This ain't your grandmother's benzoyl peroxide and it ain't your grandmother's tretinoin. In this product, they are microencapsulated, so individually, benzoyl peroxide crystals and tretinoin crystals are microencapsulated in a silica shell. Those tiny little capsules, which are mostly less than 10 microns in size, are put into a moisturizing creamy base.
What that does is 2 things. The first is that most of us will remember that tretinoin and benzoyl peroxide don't play well together in the sandbox: the benzoyl peroxide inactivates by oxidizing tretinoin so that it's no longer effective. Here, because the 2 are segregated inside the cream, they do not come into contact with each other and that is no longer a problem. The second issue is that you might think, the strongest of the tretinoins and 3% benzoyl peroxide, they're both concentration dependent irritants. Isn't that going to be too much for the patient? Well, that microencapsulation means that it takes a while for the active ingredients to get out. They escape through microchannels in the layers of silica—which is sort of like the head of a cabbage, for example—[and] sneak out slowly about 50% over an hour's time. So, because it's coming out slowly, you don't end up with 1 big bolus of medication on the skin all at once, which reduces irritation and results in the good tolerability data that this drug has shown.
What can you tell us about the clinical data and research that went into this product?
Twyneo has finished its phase 3 clinical trial, in which patients were randomized in 2 separate studies to receive either Twyneo or the vehicle in a 2:1 ratio daily for a 3 month period of time. The efficacy data was quite good. Overall, at the end of 12 weeks, 32% of patients [were] clear or near clear, with a reduction of both inflammatory and noninflammatory lesions in the high 60s. More importantly though, perhaps: at 2 weeks and at 4 weeks, a very high reduction of both inflammatory and noninflammatory lesions of about 25% and then 40%.
Now, what does that mean to us as clinicians? It means that the patients are getting better rapidly, and that means they're more likely to comply with therapy so that, ultimately, they get up to that high level of of improvement. So a nice jackrabbit start so the patients are quickly seeing results and tending to use their medication more regularly.
The flip side of the coin, of course, is tolerability. The most efficacious drug on the planet isn't going to get used if it's not tolerable. So [Twyneo was] very well tolerated despite the fact, again, that it's the strongest tretinoin and benzoyl peroxide together in 1 product. Looking at local tolerability in both of those studies, the mean tolerability scores of all parameters—erythema, stinging, burning, itching, peeling—[were] all well below mild. Even with a little blip at that 2 week mark, just the way we normally see for topical retinoids, returning right back towards vehicle in a very short period of time, so extremely well tolerated over the long haul.