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Thread: Paper on mirvaso, rhofade, rebound.

  1. #1
    Senior Member laser_cat's Avatar
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    Default Paper on mirvaso, rhofade, rebound.

    Good article (2017) for those interested on mirvaso, rhofade, + potential for rebound, for those interested :

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605221/

    Table 1 has a good summary

  2. #2
    Senior Member Mistica's Avatar
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    Quote Originally Posted by laser_cat View Post
    Good article (2017) for those interested on mirvaso, rhofade, + potential for rebound, for those interested :

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605221/

    Table 1 has a good summary
    Fortunately, these reactions resolve, but they can lead to discontinuation of therapy in many cases and/or may dissuade some clinicians from treating other rosacea patients with topical brimonidine
    [quoteIt has been noted over time that 10 to 20 percent of patients treated with brimonidine 0.33% gel experience reversible worsening of facial erythema, usually presenting.... ][/quote]

    Can't these scientists ever tell the truth???!!! I don't believe for one minute, staff from Galderma and those involved in the studies haven't read the numerous reports by brimonidine victims on this forum. In fact, I think they drop by for ideas as to which drug to push next. Rhofade was one such recent example, perhaps? At the end of the day such blatant misrepresentation of victim's experiences screams of a complete lack of ethics.
    Previous Numerous IPL.
    Supplements: Niacinamide, Vit K2, low D3, Moderate Dose Vit C, Iodine, Taurine, Magnesium. Very low dose B's. Low dose zinc (to correct deficiency).
    Skin Care: No Cleanser, ZZ cream mixed with Niacinamide gel 4% and LMW HA.

    Treating for gut dysbiosis under specialist care. (This is helping).
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  3. #3
    Senior Member Mistica's Avatar
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    Sorry, I don't know why the quote option didn't apply properly in above post.

    Physicians should be speaking up too. If there is truly a lack of honest communication between those prescribing the drug and those in pharmaceutical companies, then, shame on them as well.
    Last edited by Mistica; 29th March 2018 at 04:06 AM.
    Previous Numerous IPL.
    Supplements: Niacinamide, Vit K2, low D3, Moderate Dose Vit C, Iodine, Taurine, Magnesium. Very low dose B's. Low dose zinc (to correct deficiency).
    Skin Care: No Cleanser, ZZ cream mixed with Niacinamide gel 4% and LMW HA.

    Treating for gut dysbiosis under specialist care. (This is helping).
    Previous GAPS diet. Testing tolerance of resistant starch.
    Fermented Foods. 2 to 3 days per week, Intermittent fasting -16-18 hours.

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    Senior Member Brady Barrows's Avatar
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    James Q. Del Rosso, DO, FAOCD, FAAD, the author of the paper published in the Journal of Clinical and Aesthetically Dermatology, is one of the current directors and past president (2009-2011) of the AARS. He comments on the rebound issue with brimonidine with this statement:


    "It is not entirely clear why some individuals treated for rosacea with brimonidine 0.33% gel experience worsening of facial erythema or why different clinical patterns of worsening of erythema may occur. Fortunately, these reactions resolve, but they can lead to discontinuation of therapy in many cases and/or may dissuade some clinicians from treating other rosacea patients with topical brimonidine."


    It is clear why brimonidine causes worsening of erythema (rebound) because "brimonidine treats reddened skin (erythema) by causing narrowing of blood vessels (vasoconstriction)." Wikipedia


    After the effects of brimonidine wears off vasodilation returns big time. And the more you use it, the worse the vasodilation causes rebound and the accompanying erythema.


    With Rhofade (Oxymetazoline Hydrochloride) Del Rosso writes, "These data suggest that treatment-related worsening of facial erythema occurring during active use and/or after discontinuation of therapy (defined as rebound in pivotal clinical studies) are uncommon with oxymetazoline hydrochloride 1% cream." The data was that "Adverse reaction reporting captured during treatment phases showed that application-site erythema was noted in one percent of actively treated subjects versus 0.4 percent in vehicle-treated subjects in the pivotal studies and in two percent of actively treated subjects in the long-term study."


    The results reported in RF indicate that there is less rebound and worsening of erythema with Rhofade (Oxymetazoline Hydrochloride) than with Mirvaso (brimonidine). Dr. Del Rosso states in conclusion, "Clinical trials completed with oxymetazoline 1% cream suggest a low to negligible risk of worsening of facial erythema or rebound, although postmarketing clinical experience with oxymetazoline is still early."


    Dr. Del Rosso then asks this question: "Is it possible that different adrenergic receptor binding properties and pharmacologic/pharmacodynamic activities between the topical α-agonists can result in differences in the potential for worsening of facial erythema of rosacea, such as paradoxical erythema (occurring within 46 hours after drug application) or rebound (occurring after the effect of drug has dissipated or therapy is stopped)?" Of course, there could be differences.


    My latest comment on the AARS is worth reading.
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    So does it look like Rhofade will produce less patients with rebound?

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    Quote Originally Posted by redattack View Post
    So does it look like Rhofade will produce less patients with rebound?
    Maybe. However, I have read that Rhofade will not be introduced in Europe... so I guess we cannot try ourselves

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    Quote Originally Posted by timo View Post
    Maybe. However, I have read that Rhofade will not be introduced in Europe... so I guess we cannot try ourselves
    dam it would like to try it

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    Senior Member nat007's Avatar
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    Also interesting about the researcher:

    DISCLOSURES:In relationship to this manuscript, Dr. Del Rosso serves as a consultant, speaker, and research investigator for Bayer HealthCare Pharmaceuticals (Dermatology). He is also a consultant, speaker, and research investigator for other companies that market products used to treat rosacea, such as Allergan, Galderma, and Valeant. Dr. Del Rosso has served as the sole author of this article and has not received any form of payment for writing and submitting this article.

    I am not buying the low rebound percentage mentioned in this research paper
    Uses: 22,5 mg mirtazapine, clonidine and propranolol, Xyzal at times.
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    Quote Originally Posted by nat007 View Post
    Also interesting about the researcher:

    DISCLOSURES:In relationship to this manuscript, Dr. Del Rosso serves as a consultant, speaker, and research investigator for Bayer HealthCare Pharmaceuticals (Dermatology). He is also a consultant, speaker, and research investigator for other companies that market products used to treat rosacea, such as Allergan, Galderma, and Valeant. Dr. Del Rosso has served as the sole author of this article and has not received any form of payment for writing and submitting this article.

    I am not buying the low rebound percentage mentioned in this research paper
    I think your quote says all we need to know about the article - thanks for pointing that out!

  10. #10
    Senior Member laser_cat's Avatar
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    Hi, I didn't mean to offend anyone by sharing the article. My interest wasn't in whether rhofade will have rebound or not (I will likely never try it myself...just too risky for me personally), but in the mechanism of rebound on the molecular level. I had assumed I guess naively that application of mirvaso eg would just downregulate the number of alpha 2 receptors. But I thought it was interesting that other potential mechanisms at play are -

    - alpha 2 receptor on vascular smooth muscle (causing vasoconstriction) vs. alpha 2 receptor on endothelial cells (causing vasodilation), and the times when the vasodilation may dominate (eg hormonal input)

    - presynaptic alpha 2 receptors inhibit norepinephrine release (norep. would constrict). So if in a rosacea patient, the postsynaptic alpha 2 receptors are few and far between (the postsynaptic ones cause vasoconstriction, and I'm guessing is downregulated by repeated Mirvaso use), this could also contribute to mirvaso-induced dilation.

    Admittedly some of these details are over my head but I'm trying to learn more about them.

    The more we can learn about these mechanisms I think at the fundamental level, the better we can assess future topicals, and more clearly explain to derms in precise terms maybe why and how mirvaso/rhofade might cause rebound. (There's been too many appts where it is recommended that I try mirvaso/rhofade, and I wish I could offer better explanations than just saying "rebound"..) And the more insight we get as to why we might be flushing like crazy to begin with.

    best wishes

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