Is mometasone more potent than betamethasone?

Is Mometasone Stronger Than Betamethasone?

Mometasone furoate 0.1% and betamethasone dipropionate 0.05% are classified in the same potency category (Class III/high-potency), but mometasone demonstrates superior anti-inflammatory activity, longer duration of action, and a better safety profile with less cutaneous atrophy. 1

Potency Classification

Both agents occupy the same tier in formal classification systems:

• Mometasone furoate 0.1% is classified as Class III (high-potency/potent) by the American Academy of Dermatology 1, 2
• Betamethasone dipropionate 0.05% is also classified as Class III (potent) in its standard formulation 1
• Important distinction: Betamethasone dipropionate potentiated 0.05% is classified as super-potent (Class I-II), which is a different formulation 1

Pharmacological Superiority of Mometasone

Despite identical classification, mometasone exhibits measurably superior characteristics:

Anti-Inflammatory Activity

• Mometasone furoate demonstrates greater anti-inflammatory activity than betamethasone 2, 3
• In UV-B-induced inflammation assays, mometasone 0.1% was more than twofold better at reducing inflammation compared to betamethasone dipropionate 0.05% and betamethasone valerate 0.1%, with effects sustained for at least 24 hours after a single application 4
• Mometasone has the highest relative binding affinity for the glucocorticoid receptor among topically active corticosteroids tested, and is the most potent stimulator of glucocorticoid receptor-mediated gene transcription 5

Duration of Action

• Mometasone has a longer duration of action than betamethasone 2, 3
• This translates to clinical convenience: mometasone 0.1% applied once daily achieves comparable efficacy to betamethasone valerate 0.1% applied twice daily 6

Safety Profile

• Mometasone presents a superior safety profile with less cutaneous atrophy compared to betamethasone dipropionate 1
• It has low atrophogenic potential, no greater than other glucocorticoids in its class such as betamethasone valerate 2
• Mometasone's molecular biotransformation in skin results in lower affinity with dermal cells than epidermal cells, contributing to its low atrophogenicity 3
• It demonstrates low systemic availability due to high lipophilicity, low percutaneous absorption, and rapid hepatic biotransformation, with no significant effect on the hypothalamic-pituitary-adrenal axis 3

Clinical Efficacy Comparisons

Head-to-Head Studies

• European dermatological evidence suggests mometasone furoate 0.1% applied once daily has shown superior or equivalent efficacy to betamethasone dipropionate 0.05% applied twice daily 1
• In atopic dermatitis, mometasone 0.1% once daily produced effects similar to betamethasone dipropionate 0.05% twice daily over 2-3 weeks 2
• In psoriasis management, mometasone 0.1% once daily for 2-8 weeks was generally more effective than betamethasone valerate 0.1% 2
• After 21 days of treatment for various dermatoses, mometasone once daily achieved 93.6% improvement versus betamethasone valerate twice daily achieving 96.5% improvement—clinically equivalent outcomes with half the application frequency 6

Practical Implications

The key clinical advantage is that mometasone achieves comparable or superior results with once-daily dosing versus twice-daily dosing required for betamethasone formulations of similar classification 1, 6. This improves adherence while maintaining or enhancing efficacy.

Important Caveats

• When comparing these agents, formulation matters critically: betamethasone dipropionate potentiated 0.05% is super-potent (Class I-II) and would be stronger than standard mometasone 0.1% 1
• Both agents are classified as high-potency and should be avoided on the face, intertriginous areas, and zones susceptible to steroid atrophy 1
• For psoriasis treatment specifically, guidelines note that mometasone furoate 0.1% cream is classified as Class IV when used in combination studies 7, though this may reflect specific formulation or study design rather than inherent potency
• The superior safety profile of mometasone makes it particularly advantageous for long-term or maintenance therapy where minimizing atrophy risk is paramount 1, 3