A Network Meta-Analysis of the Relative Efficacy of Treatments for Actinic Keratosis of the Face or Scalp in Europe

Abstract

BackgroundSeveral treatments are available for actinic keratosis (AK) on the face and scalp. Most treatment modalities were compared to placebo and therefore little is known on their relative efficacy.ObjectivesTo compare the different treatments for mild to moderate AK on the face and scalp available in clinical practice in Europe.MethodsA network meta-analysis (NMA) was performed on the outcome “complete patient clearance”. Ten treatment modalities were included: two 5-aminolaevulinic acid photodynamic therapies (ALA-PDT), applied as gel (BF-200 ALA) or patch; methyl-aminolevulinate photodynamic therapy (MAL-PDT); three modalities with imiquimod (IMI), applied as a 4-week or 16-week course with 5% imiquimod, or a 2–3 week course with 3.75% imiquimod; cryotherapy; diclofenac 3% in 2.5% hyaluronic acid; 0.5% 5-fluorouracil (5-FU); and ingenol mebutate (IMB). The only data available for 5% 5-FU was from one small study and was determined to be too limited to be reliably included in the analysis. For BF-200 ALA and MAL-PDT, data from illumination with narrow-band lights were selected as these are typically used in clinical practice. The NMA was performed with a random-effects Bayesian model.Results25 trials on 5,562 patients were included in the NMA. All active treatments were significantly better than placebo. BF-200 ALA showed the highest efficacy compared to placebo to achieve total patient clearance. BF-200 ALA had the highest probability to be the best treatment and the highest SUCRA score (64.8% and 92.1%), followed by IMI 5% 4 weeks (10.1% and 74.2%) and 5-FU 0.5% (7.2% and 66.8%).ConclusionsThis NMA showed that BF-200 ALA, using narrow-band lights, was the most efficacious treatment for mild to moderate AK on the face and scalp. This analysis is relevant for clinical decision making and health technology assessment, assisting the improved management of AK.

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

“…The included drugs comprised BF-200 ALA, ALA-patch, MAL, three modalities of imiquimod (3.75-5.0%), cryotherapy, 3% diclofenac in 2.5% hyaluronic acid, 0.5% 5-FU and ingenol mebutate. The metaanalysis indicates that all treatment options were significantly superior compared with placebo, with BF-200 ALA photodynamic therapy being the most efficient treatment [37]. This finding is corroborated by the findings of Dirschka et al who studied and compared 1 year follow-up treatments for selected AK treatment modalities and, among those, found BF-200 ALA to show the most sustainable efficacy [39].…”

“…In clinical studies, PDT with aminolevulinic acid (ALA) has been shown to achieve good results within a short time and a maximum of two treatment sessions [37,38]. Several ALA-based topical medications have been used, mostly differing in regard to additional chemical modifications, other vehicle compositions, types of administration or the use of other wavelengths.…”

“…The relative efficacy of ten different treatment modalities has been analyzed in a European network metaanalysis (NMA) [37]. Study selection was based on the Cochrane systematic search and review for actinic keratosis treatments [38].…”

Actinic keratoses treated with cold atmospheric plasma

“…7 This intraepidermal keratinocytic dysplasia may transform into invasive squamous cell carcinoma (SCC) in up to 20% within 10-25 years. 8 Although various therapy options exist, they often bear undesirable sideeffects. 7 To see whether CAP could be an effective therapy option, we treated seven patients (two females, five males) with Fitzpatrick skin types II or III and clinically diagnosed AK in this proof of concept study.…”

Topical agents for preventing and treating actinic keratosis

“…27 Of 25 trials included, 18 were of topical treatments. Description of the regimens utilised was incomplete, but it appears that 12 trials corresponded to the treatments or formulations used in the UK.…”