Mirvaso is indicated for symptom treatment of facial erythema caused by rosacea in adult patients. Mirvaso contains brimonidine, an alpha2-adrenergic receptor agonist with vasoconstricting properties, and is likely to work by constricting dilated facial blood vessels.
Previously, topical treatment of rosacea only comprised azelaic acid and metronidazole, which are also specifically indicated for erythema caused by rosacea. Long-term use of antibiotics is problematic in relation to the development of bacterial resistance, and it is encouraging that another alternative to topical treatment with metronidazole is now available. Moreover, an effect of treatment with Mirvaso is achieved after only 30 minutes, whereas the effect of metronidazole often occurs after treatment for a couple of weeks (however, no studies of metronidazole as an active comparator have been conducted). In addition, Mirvaso is applied once daily, whereas metronidazole is dosed twice daily. However, treatment with Mirvaso is estimated to be twice as expensive as topical treatment with metronidazole. Mirvaso has also been reported to exacerbate erythema, both after a single treatment and during long-term use, which may be associated with the mechanism of action.
Its IRF’s overall assessment, that Mirvaso can be an alternative to metronidazole in the treatment of erythema in the sub-group of patients with rosacea with limited inflammation. Moreover, Mirvaso can be used as add-on to other treatment against rosacea to achieve adequate symptom control of erythema. Local treatment is associated with fewer adverse events and lower risk of drug interactions and is thus generally preferred over systemic therapy.
Patients should be informed about the risk of worsening of erythema and should be advised to apply the gel on a small test area at the start of treatment.
Mirvaso was marketed on 28 April 2014. It is currently possible to apply for single reimbursement.