Triple Combination: Clindamycin, Benzoyl Peroxide, and Adapalene


An overview of the combination therapy of clindamycin, benzoyl peroxide, and adapalene.

Casey Butrus, PharmD: Hilary, we have some innovation coming along the lines and pipeline for acne. I know there’s 1 product specifically, a triple combination product, which we haven’t historically seen, which has clindamycin, benzoyl peroxide, and adapalene, so an antibiotic, antibacterial, and retinoid. What are your thoughts on some of these pipeline products, specifically that product?

Hilary Baldwin, MD: Barring any unforeseen problems, we’re going to have what’s still called IDP-126 [clindamycin, benzoyl peroxide, and adapalene] on the shelves by the end of this year or the first quarter of next year. And as you mentioned, [this is] our first triple combination, which we’ve been waiting for, for a very long time, and it hits 3 of the 4 pathogenic factors of acne. So with 1 application per day, [this is] highly statistically significantly superior to the duads, each one of the double combinations that we have been using for years is almost twice as effective as every single one of the duads. I don’t know if you guys have seen this study, but they did a study on the number needed to treat, which is the number of people that you needed to have in the study in retrospect, to show statistical significance. It was so effective that all they needed was 4 people in each arm to have shown statistical significance. Some of our acne medications have 5,000, or 4,000 people enrolled to show statistically significant differences. But here, in retrospect, all they had to do was study 16 patients and they would have been done with it. But very effective, and very well tolerated. I’m very much looking forward to having that in my hands. There are others. There’s another sebum inhibitor that degrades what is a GT20029 or something, which is supposed to actually degrade the androgen receptor and decrease sebum production that way. It’s only been through phase 1 trials, though. [There are] no safety signals,very minimal systemic absorption, [and it is] well-tolerated. So hopefully that drug will make it through to the end. We also have lots of companies looking at biologics that are targeting interleukin-1 beta and 17 and 23 and TNF [tumor necrosis factor] α, which might help with the inflammatory process of acne. And finally, acne vaccines. The vaccine is actually not intended to stop acne altogether. The idea would be to stop acne from transitioning from mild to moderate to severe. And some of the companies are getting pretty close and looking at not reducing [Cutibacterium] acnes counts but reducing the virulence of the C acnes organism. So it stays there. Its numbers still occupy their niche so that they don’t end up also changing the bacterial commensalism that’s part of the normal microbiome of the skin. So it’s an exciting time.

Casey Butrus, PharmD: Yeah, I definitely agree. [It’s] very exciting. And just from the managed care perspective I think it’s going to get interesting how we manage cost with biologics for a condition that millions of people have and is so prevalent in the United States. So where do we draw the line of who is a candidate for these therapies and how do we make sure that the appropriate patients get the access that they need for these therapies, too?

Transcript edited for clarity.

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