Comparing the efficacy of field treatments for actinic keratosis: a critical appraisal of a randomized trial in the New England Journal of Medicine. (3rd February 2020)

• Record Type: Journal Article
• Authors: Wehner, M.R.
• Is Part Of: British journal of dermatology. Volume 182:Number 6(2020)
• Page Start: 1343
• Page End: 1344
• Publication Date: 2020-02-03
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.18537
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Aim: Jansen et al . conducted a randomized trial to compare the efficacy of four field treatments for actinic keratosis (AK). Setting and design: This was a multicentre, single‐blind, randomized trial conducted in the dermatology departments of four Netherlands hospitals. Patients were not blinded. The investigator who evaluated the trial outcome was blinded. Study exposure: This study included adult patients with at least five AKs on the face or vertex scalp. Patients were randomized to treatment with fluorouracil 5% cream, imiquimod 5% cream, methyl aminolaevulinate photodynamic therapy (MAL‐PDT) or ingenol mebutate 0·015% gel. Outcomes: The primary outcome was whether patients had ≥ 75% reduction in AK count 12 months after treatment. Results: In total 624 patients participated. The likelihood of having ≥ 75% reduction in AK count 12 months after treatment was significantly higher (twice as high or greater) for fluorouracil than for any other therapy. Approximately 75% of patients treated with fluorouracil experienced ≥ 75% reduction in AK count at 12 months. Conclusions: Jansen et al . conclude that 1 year after treatment, fluorouracil was significantly more effective at AK reduction than imiquimod, MAL‐PDT or ingenol mebutate.