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Comment & Response |

Primary Nonadherence in Acne Treatment: The Importance of Cost Consciousness

Courtney B. Rubin, BS1; Jules B. Lipoff, MD2
[+] Author Affiliations
1Perelman School of Medicine at the University of Pennsylvania, Philadelphia
2Department of Dermatology, University of Pennsylvania, Philadelphia
JAMA Dermatol. 2015;151(10):1144-1145. doi:10.1001/jamadermatol.2015.1743.
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To the Editor We read with interest the article by Anderson and colleagues1 that described primary nonadherence to acne treatment regimens when multiple medications were prescribed. Since patients in this study did not obtain all medications prescribed to them by their dermatologists, the conclusion was that acne treatment may not be completed if more than 1 prescription is given.

For patients with acne treated with multiple topical agents, an implication of this study is that fixed-dose combination therapies should be preferred treatments because they reduce the number of prescriptions. We would like to point out that from the limited published data available, combination therapies have not shown any improvement in efficacy compared with separately prescribed agents given in combination, despite any benefit in compliance.2 For approval of proprietary fixed-dose combination therapy, the US Food and Drug Administration merely requires pharmaceutical companies to show that each ingredient has contributed some benefit separately but does not require the fixed-dose combination to be proven superior to monotherapy or both active ingredients prescribed separately.3 This likely explains the paucity of data.

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October 1, 2015
Steven R. Feldman, MD, PhD; Kathryn Anderson, BS
1Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
JAMA Dermatol. 2015;151(10):1145. doi:10.1001/jamadermatol.2015.1744.
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