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clascoterone

Sold as Winlevi. First FDA approval 08/26/2020: 6 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

C

Score breakdown (74/100)

Safety ×35%
A
Evidence ×25%
F
Regulatory ×15%
A
Money & lawsuits ×15%
B
Options ×10%
F

Safety: 100

Evidence: 29

Regulatory history: 100

Money & lawsuits: 85

Options: 40

What the FDA label says

Approved uses

(clascoterone) cream is an androgen receptor inhibitor indicated for the topical treatment of acne vulgaris in patients 12 years of age and older. WINLEVI (clascoterone) cream is an androgen receptor inhibitor indicated for the topical treatment of acne vulgaris in patients 12 years of age and older. ( 1 )

Contraindications

None. None ( 4 )

Warnings and precautions

Local Irritation: Pruritus, burning, skin redness or peeling may be experienced with WINLEVI cream. If these effects occur, discontinue or reduce the frequency of application of WINLEVI cream. ( 5.1 ) Hypothalamic-pituitary-adrenal (HPA) axis suppression may occur during or after treatment with clascoterone. ( 5.2 ) Attempt to withdraw use if HPA axis suppression develops. ( 5.2 ) Pediatric patients may be more susceptible to systemic toxicity. ( 5.2 , 8.4 ) Hyperkalemia: Elevated potassium levels were observed in some subjects during the clinical trials. ( 12.2 ) 5.1 Local Skin Reactions WINLEVI cream may induce local irritation (erythema/redness, pruritus, scaling/ dryness). Concomitant use with other potentially irritating topical products (medicated or abrasive soaps and cleansers, soaps and cosmetics that have a strong drying effect and products with high concentrations of alcohol, astringents, spices or lime) should be limited. The product should not be applied to cuts, abrasions, eczematous or sunburned skin. 5.2 Hypothalamic-pituitary-adrenal (HPA) Axis Suppression Hypothalamic-pituitary-adrenal (HPA) axis suppression was observed and may occur during or after treatment wit...

Adverse reactions (label)

Most common adverse reactions occurring in 7 to 12% of patients are erythema/reddening, pruritus and scaling/dryness. Additionally, edema, stinging, and burning occurred in >3% of patients and were reported in a similar percentage of subjects treated with vehicle. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Sun Pharmaceutical Industries, Inc. 1-800-818-4555 or FDA at 1-800-FDA-1088 or http://www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. In two identical multicenter, randomized, double-blind, vehicle-controlled trials, 1421 subjects 12 years and older with facial acne vulgaris applied WINLEVI cream or vehicle twice daily for 12 weeks. Overall, 62% of the subjects were female, and 38% were male, 91% of the patients were Caucasian, and the mean age was 19.7 years. Local skin reactions (edema, erythema/redness, pruritus, scaling/dryness, skin atrophy, stinging/burning, striae rubrea, telangiectasia) were obse...

Source: FDA SPL label for Winlevi (Sun Pharmaceutical Industries, Inc.), effective 20250102. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

1,418reports that mention this drug
1,416of those blame this drug, not another one the person was taking
5%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
0.0%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Product Storage Error · 333Product Physical Consistency Issue · 329Product Use Complaint · 286Product Dose Omission Issue · 184Product Use Issue · 153Drug Ineffective · 146Therapy Cessation · 86Poor Quality Product Administered · 84Product Physical Issue · 78Condition Aggravated · 76Product Quality Issue · 67Acne · 46Off Label Use · 38Erythema · 30Liquid Product Physical Issue · 25

Reports per year

202120222023202420252026
450021042226913

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

0recall actions on file
1 / 0brand / generic applications
1label changes since 2021
NoREMS program

Evidence base

8randomized trials (PubMed)
2systematic reviews
24registered trials
73%of completed trials posted results
0%terminated or withdrawn
79%industry-funded

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $720,431 in payments to US physicians and hospitals tied to this drug across 16,366 transactions (Winlevi $720,431).

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

809Medicare Part D patients (2024)
1,883prescriptions filled
$595average cost per fill
$1Mtotal Medicare spend

Same-class alternatives

No same-class alternatives found in RxClass.

Questions to ask your prescriber

  1. The most-reported problems in FDA's adverse event data are product storage error, product physical consistency issue, product use complaint, product dose omission issue. How would we recognize and handle those?
  2. There is no generic. Is there an older generic in the same class that works as well for my situation?
  3. What result are we expecting, by when, and what is the plan if it does not happen?
  4. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)