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Calcitonin gene-related peptide (CGRP) inhibitors -- a group of drugs commonly used to treat migraine -- were associated with decreased rates of acne and rosacea compared with drugs that did not inhibit CGRP (topiramate) and those that did so indirectly (triptans).

That's according to results of a cohort study published in . Investigators analyzed patient data from the TriNetX US Collaborative Network, which covers 62 healthcare organizations.

Over a 1-year period, migraine patients treated with monoclonal antibodies that inhibit CGRP had significantly lower rates of acne (HR 0.71; 95% CI 0.60-0.84) and rosacea (HR 0.53; 95% CI 0.39-0.72) than those treated with triptans. Likewise, CGRP inhibition was associated with substantially decreased rates of acne (HR 0.82; 95% CI 0.69-0.98) and rosacea (HR 0.65; 95% CI 0.47-0.90) when compared with patients using topiramate.

The paper's co-author, John Barbieri, MD, MBA, is an assistant professor at Harvard Medical School and director of the Advanced Acne Therapeutics Clinic at Brigham and Women's Hospital in Massachusetts. His exchange with the Reading Room has been edited for length and clarity.

What motivated your investigation and what were its objectives?

Barbieri: Migraine and rosacea have overlapping mechanisms, including neurovascular hyperreactivity.

Since CGRP inhibition can address neurovascular hyperreactivity and is an effective treatment for migraine, we were interested in examining whether it might be effective for rosacea as well.

CGRP may also be involved in acne pathogenesis because its receptor is expressed in sebaceous glands, and CGRP signaling mediates inflammation triggered by Cutibacterium acnes.

What were the most significant findings?

Barbieri: We found that patients being treated for migraine with monoclonal antibodies that inhibit CGRP were less likely to receive new diagnoses for acne or rosacea than those treated with other migraine therapies.

These results were consistent across a range of sensitivity analyses looking at different migraine comparator groups.

What are the take-home messages for dermatologists?

Barbieri: Given that CGRP-mediated neurogenic inflammation may contribute to acne and rosacea development, CGRP inhibition could represent a novel treatment modality for these conditions.

Although no CGRP inhibitors are currently available specifically for acne or rosacea, for those who have comorbid migraine, it might be worth considering these treatment options when all other things are equal.

CGRP inhibition would be expected to be particularly helpful for those with severe redness or flushing symptoms.

What might the future hold for CGRP inhibitors in his context?

Barbieri: As there are currently no topical or systemic CGRP inhibitors approved by the [FDA] for skin conditions, this is an important area of future research.

CGRP inhibitors could be a novel treatment strategy for skin conditions, particularly those that are characterized by redness, flushing, or pain.