sarecycline
Sources réglementaires consultées
Indications approuvées
- Lésions inflammatoires de l’acné vulgaire non nodulaire modérée à sévère chez les patients à partir de 9 ans. Elle n’a pas été évaluée pour traiter les infections.
Contre-indications
Absolues
- Hypersensibilité à toute tétracycline.
Mises en garde cliniques
- Mise en garde majeure · Elle peut provoquer une coloration dentaire et une inhibition de la croissance osseuse ; ne pas utiliser avant 9 ans. — DailyMed, set_id b200957c-3004-4988-be97-9fd619a83649
- Mise en garde majeure · Éviter les rétinoïdes oraux en raison du risque d’hypertension intracrânienne. — DailyMed, set_id b200957c-3004-4988-be97-9fd619a83649
- Mise en garde majeure · Il peut provoquer une diarrhée à Clostridioides difficile, y compris après la fin du traitement ; arrêter et traiter selon la gravité. — DailyMed, set_id b200957c-3004-4988-be97-9fd619a83649
- Il peut provoquer une photosensibilité. Limiter l’exposition solaire/UV et arrêter en cas d’érythème important. — DailyMed, set_id b200957c-3004-4988-be97-9fd619a83649
Interactions médicamenteuses
- ModéréeAntiacides et préparations contenant aluminium, calcium, magnésium, bismuth ou fer
Mécanisme: La chélation réduit l’absorption orale.
Recommandation: Espacer les prises selon le RCP et administrer avec beaucoup d’eau.
DailyMed, set_id b200957c-3004-4988-be97-9fd619a83649
- SévèreRétinoïdes oraux, anticoagulants et substrats de la P-gp
Mécanisme: Les rétinoïdes augmentent l’hypertension intracrânienne ; l’anticoagulation peut être potentialisée et l’exposition aux substrats de la P-gp peut augmenter.
Recommandation: Éviter les rétinoïdes ; surveiller l’INR et la toxicité des substrats P-gp à marge étroite.
DailyMed, set_id b200957c-3004-4988-be97-9fd619a83649
Effets indésirables
Communs (≥1%)
Nausées
Rares mais graves
Hypertension intracrânienne, anaphylaxie et œsophagite ulcéreuse
Grossesse et allaitement
Elle peut provoquer une atteinte fœtale ; arrêter la sarécycline dès que la grossesse est reconnue. L’allaitement n’est pas recommandé pendant le traitement.
Bibliographie récente (PubMed)
Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. The objective of this study was to provide evidence-based recommendations for the management of acne. A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. Analysis is based on the best available evidence at the time of the systematic review. These guidelines provide evidence-based recommendations for the management of acne vulgaris.
Although many treatments are available for acne, these can be limited by lack of effectiveness, patient tolerance and adherence, and accessibility. This review provides a comprehensive summary of the latest developments in acne management, exploring a range of topical, systemic, and procedural treatments. The mechanisms of action, pivotal trial data, and potential role in clinical practice are reviewed for emerging therapies such as 1726 nm laser, sarecycline, clascoterone, trifarotene, minocycline foam, and fixed-dose combination topicals. The clinical pipeline is also summarized. In addition, opportunities to improve the patient experience with spironolactone and isotretinoin are discussed. No information is available on the use of sarecycline during breastfeeding. For acne treatment, it is taken for 12 weeks or longer. Such prolonged courses of tetracyclines are not recommended because if even a small fraction is absorbed by the infant from milk, it could have a cumulative staining effect on the infant’s permanent teeth.
Cutibacterium acnes protects skin homeostasis. The species has three subspecies, and associations between C. acnes subsp. acnes and acne, C. acnes subsp. defendens and prostate cancer, and C. acnes subsp. elongatum and progressive macular hypomelanosis have recently been suggested. Different phylotypes/clonal complexes may cause prosthetic joint and other infections, and virulence factors such as fimbriae, biofilms, multidrug-resistance plasmids, porphyrin, Christie-Atkins-Munch-Petersen factors and cytotoxicity contribute to infections. Isolates are subtyped by multiplex PCR or multi- or single-locus sequence typing; however, these methods could be better synchronized. Resistance of acneic strains to macrolides (25.0-73.0%), clindamycin (10.0-59.0%) and tetracyclines (up to 37.0%) is worrisome, but susceptibility testing is now facilitated by European Committee on Antimicrobial Susceptibility Testing disk diffusion breakpoints. New therapeutic approaches include sarecycline, antimicrobial peptides and bacteriophages. What is this summary about? Cutibacterium acnes is necessary for skin health. However, different subspecies and types may be associated with different diseases. At present, the species has three known subspecies and six known major phylotypes. What were the results? Acne results from a disturbance of the skin bacteria. It has often been linked to C. acnes, whereas associations of other subspecies with prostate cancer, skin disease and various infections have been observed. Strain typing can be performed with different techniques; however, methods should be better synchronized. Resistance of isolates from acne to antibiotics is high. Antibiotic susceptibility testing is necessary and is being facilitated. New treatments with newer antibiotics, antimicrobial peptides and phages are promising. What do the results mean? C. acnes has three subspecies and numerous types that can support skin health or be linked to different diseases. New associations between