Metronidazole vs. Ivermectin

Summary and Comment |
March 15, 2016

Metronidazole vs. Ivermectin

  1. Mark V. Dahl, MD

Which drug for remission of rosacea?

  1. Mark V. Dahl, MD

Topical metronidazole 0.75% cream (MET) twice daily and ivermectin 1% cream daily (IVER) both effectively treat the papulopustular component of rosacea. Is one better at producing remissions? Investigators conducted a 36-week, randomized, parallel group phase III study to find out.

They enrolled 399 patients who had been judged clear or almost clear (Investigators Global Assessment [IGA] score, 0 or 1) after 16 weeks of treatment in an earlier, phase III, investigator-blinded, randomized, parallel group study showing superiority of IVER for reducing papule and pustule counts (P<0.001). These patients now stopped treatment. If recurring papules and pustules warranted an IGA score of ≤2, patients resumed their original topical treatment until remission was again obtained. Primary endpoints were relapse rate and days to first relapse.

The median number of days to first relapse was higher in IVER recipients (median, 115 days; 95% confidence interval, 113–165 days) than in MET recipients (median, 85 days; 95% CI, 85–113 days). The relapse rate by study end at 36 weeks was lower for IVER recipients (62.7%) than MET recipients (68.4%). No serious adverse treatment-related events were recorded.


As in other rosacea remission studies, remissions were maintained after treatment with both drugs. Some remissions proved quite durable. At the start of the remission study, more IVER recipients than MET recipients had IGA scores of 0, so the IVER group was winning at the start. The number of subjects was large (n=762), but even so, the between-group difference in remission rates was small (P =0.037). In my opinion, topical IVER can successfully and safely treat the papulopustular elements of rosacea and produce durable remissions. This places topical IVER treatment among other first-tier treatments.

Editor Disclosures at Time of Publication

  • Disclosures for Mark V. Dahl, MD at time of publication Consultant / Advisory board Ulthera, Inc.; AuBio LifeSciences, LLC; Paris Therapeutics Equity Elorac, Inc.; Makucell, Inc.; Paris Therapeutics Editorial boards UpToDate Leadership positions in professional societies National Rosacea Society (Chairman, Medical Board)


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