Table 2.
Head-to-head comparison studies of COC formulations in acne treatment
| Duration of Study | Type of Study | Dosages Studied | Results | |
|---|---|---|---|---|
| DSG and EE vs. LNG and EE | ||||
| DSG + EE vs. LNG + EE. Which one has better effect on acne, hirsutism, and weight change (Sanam and Ziba, 2011, Tanghetti et al., 2014). | 1 year | Randomized clinical trial | 30 μg EE, 0.15 mg progestin (either DSG or LNG) | Both acne and hirsutism were more significantly improved in the DSG/EE group vs. the LNG/EE group (p = .000). Weight gain was significantly greater in the LNG/EE group (p = .000). |
| A randomized controlled trial of second- versus third-generation oral contraceptives in the treatment of acne vulgaris (Rosen et al., 2003). | 9 months | Randomized control trial | 30 μg EE, 0.15 mg progestin (either DSG or LNG | Mean acne lesion count was significantly reduced in both groups (p < .02). There was no statistically significant difference in acne lesion count reduction between the two groups (58.5% DSG vs. 52.8% LNG); limited power (5%). |
| Cycle control, quality of life and acne with two low-dose oral contraceptives containing 20 microg EE (Winkler et al., 2004). | Group-comparative, randomized, multicenter trial (sponsored study) | 20 μg EE/0.15 mg DSG vs. 20 μg EE/0.10 mg LNG | The DSG/EE group had fewer acne lesions compared to the LNG/EE group at the endpoint of six cycles of treatment (p < .05). | |
| DSG/EE v.s CPA/EE | ||||
| Comparison of the effect on acne with a combiphasic DSG-containing oral contraceptive and a preparation containing CPA (Vartiainen et al., 2001). | Six 28-day cycles (approximately 6 months) | Open, randomized, group-comparative, multicenter study | First 7 days: 5 μg DSG/40 μg EE; After 15 days: 125 μg DSG/30 μg EE vs. 2 mg CPA/35 μg EE (for entire cycle) | Patients in both groups experienced statistically significant decreases in all acne lesion counts after cycle 3 and at the end of the 6-month study (p ≤ .003). There were no significant differences in acne reduction between the groups. |
| DSG/EE vs. NGM/EE | ||||
| A comparison of multiphasic oral contraceptives containing NGM or DSG in acne treatment: A randomized trial (Jaisamrarn et al., 2014). | 6 months | Investigator-blinded, randomized, parallel group trial, multicenter (investigator-initiated) | EE/DSG: days 1-7: 0.04 mg EE/0.025 mg DSG; days 8-22: 0.03 mg EE/0.125 mg DSG EE/NGM: days 1-7: 0.035 EE/0.18 NGM mg, days 8-14: 0.035 EE/0.215 NGM mg, days 15-21: 0.035 EE/0.25 NGM mg. |
At the end of 6 months, no statistically significant differences were seen in acne lesion count reduction between the two groups. Percentage decreases in acne lesion count: EE/NGM: 74.4% vs. EE/DSG: 65.1%, p = .070 |
| CMA/EE vs. LNG/EE | ||||
| Acne resolution rates: Results of a single-blind, randomized, controlled, parallel phase III trial with EE/CMA (Belara) and EE/LNG (Microgynon; Worret et al., 2001) | Twelve 28-day cycles (approximately 1 year) | Single-blind, randomized, controlled, parallel phase III trial (sponsored study) | 0.03 mg EE/2 mg CMA vs. 0.03 mg EE/0.15 mg LNG | A greater percentage of CMA patients demonstrated at least a 50% reduction in papules and pustules by the 12th treatment cycle (59.4% vs. 45.9% p = .02) |
| CPA/EE vs. DRSP/EE | ||||
| The effect of 2 combined oral contraceptives containing either DRSP or CPA on acne and seborrhea (van Vloten et al., 2002). | Nine 28-day cycles (approximately 9 months) | Multicenter, double-blind, randomized study | 30 μg EE/3 mg DSRP vs. 35 μg EE/2 mg CPA | No significant differences in efficacy between CPA and DSRP formulations with both treatments achieving comparable lesion count reductions after nine cycles of treatment. |
| CPA/EE vs. dienogest/EE | ||||
| Efficacy of a combined oral contraceptive containing 0.030 mg EE/2 mg dienogest for the treatment of papulopustular acne in comparison with placebo and 0.035 mg ethinylestradiol/2 mg cyproterone acetate (Palombo-Kinne et al., 2009). | Six 28-day cycles (approximately 6 months) | Multinational, multicenter, three-arm, double-blind and randomized trial (investigator-initiated) | 0.035 mg EE/2 mg CPA vs. 0.030 mg EE/2 mg DNG | EE/DNG was shown to be superior to placebo and non-inferior to EE/CPA in reducing acne lesion count (p < .05) |
| CMA/EE vs. DRSP/EE | ||||
| Effects of two estroprogestins containing EE 30 microg and DRSP 3 mg and EE 30 microg and CMA 2 mg on skin and hormonal hyperandrogenic manifestations (Lello et al., 2008). | 6 months | Randomized clinical trial (investigator-initiated) | 30 μg EE/3mg DRSP vs. 30 μg EE/2 mg CMA | Both groups demonstrated significant acne reduction from baseline (p < .01) by the end of study. The EE/DSRP response was better (faster and more prominent) at 3 months compared with the EE/CMA group (p < .05). The reduction in acne at 6 months was the same for both groups. |
CMA, chlormadinone acetate; COC, combined oral contraceptive; CPA, cyproterone acetate; DRSP, drosperinone; DSG, desogestrel; EE, ethinylestradiol; LNG, levonorgestrel; NGM, norgestimate.