Comparative efficacy and safety of clindamycin phosphate/benzoyl peroxide versus adapalene/benzoyl peroxide in acne treatment: a systematic review and meta-analysis

Acne vulgaris is a common dermatological disorder, primarily affecting adolescents and young adults, often leading to both physical and psychological distress. Combination therapies such as Clindamycin phosphate/Benzoyl Peroxide (CLIN/BPO) and Adapalene/Benzoyl Peroxide (ADAP/BPO) are widely used for treatment; however, direct comparative analyses of their efficacy and safety remain limited. This systematic review and meta-analysis aimed to compare the efficacy and safety profiles of CLIN/BPO versus ADAP/BPO in the treatment of acne vulgaris. A systematic literature search was conducted following PRISMA guidelines across PubMed, Scopus, Web of Science, and Cochrane Library databases. Randomized controlled trials (RCTs) comparing CLIN/BPO with ADAP/BPO were included. Data on treatment-emergent adverse events (TEAEs), treatment discontinuation due to TEAEs, AS reactions, and total lesion count were extracted and analyzed using RevMan 5.3 with a fixed effects model. Three RCTs from the USA and Argentina, including 556 participants, were analyzed. The risk of bias assessment classified two studies as low-risk and one with some concerns. The meta-analysis demonstrated that CLIN/BPO significantly reduced the risk of TEAEs compared to ADAP/BPO (OR = 0.32; 95% CI: 0.21–0.47; p < 0.0001). Additionally, treatment discontinuation due to TEAEs was lower with CLIN/BPO (OR = 0.10; 95% CI: 0.02–0.55; p = 0.008). CLIN/BPO was associated with fewer application site (AS) side effects (OR = 0.40; 95% CI: 0.28–0.55; p < 0.00001), particularly in terms of reduced pain, dryness, and irritation. However, no significant differences were observed in AS exfoliation, dermatitis, erythema, or pruritus. Both treatments showed comparable efficacy in reducing total lesion count (MD = 2.55; 95% CI: -4.11 to 9.22; p = 0.45). CLIN/BPO exhibits a superior safety and tolerability profile compared to ADAP/BPO, with significantly lower rates of TEAEs and AS reactions, while maintaining equivalent efficacy in lesion reduction. These findings suggest that CLIN/BPO may be the preferred option for patients prioritizing safety without compromising treatment effectiveness.