Patient assessment of 5-fluorouracil and imiquimod for the treatment of actinic keratoses: a retrospective study of real-world effectiveness

Emmerich, Veronica K.; Cull, Deborah; Kelly, Katherine A.; Feldman, Steven R.

doi:10.1080/09546634.2021.1917758

Cited by 7 publications

(7 citation statements)

References 14 publications

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“…Flu-like symptoms may also arise and increase in a dose-dependent manner [ 29 ]. High rates of skin reactions, prolonged discomfort, and the continued need for procedural treatments may make patients less willing to use imiquimod or topical 5-FU for AK [ 52 ]. Because of the very common local skin reactions due to its mechanism of action, treatment with imiquimod is not recommended during summer and is not the first choice in immunosuppressed patients.…”

Section: Home-based Treatmentsmentioning

confidence: 99%

A Review of Existing Therapies for Actinic Keratosis: Current Status and Future Directions

et al. 2022

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Actinic keratosis (AK) is a chronic skin disease in which clinical and subclinical cutaneous lesions coexist on sun-exposed areas such as the head and neck region and the extremities. The high prevalence of AK means the disease burden is substantial, especially in middle-aged and elderly populations. Evidence indicates that AK may progress into invasive cutaneous squamous cell carcinoma, so the European guidelines recommend treatment of any AK regardless of clinical severity. Given the aging population and therefore the increasing incidence of AK and cutaneous field carcinogenesis, further updates on the long-term efficacy of current therapies and new investigational agents are critical to guide treatment choice. Patients often have difficulty adequately applying topical treatments and coping with adverse local skin reactions, leading to less than optimum treatment adherence. The development of associated local skin symptoms and cosmetic outcomes for the area of interest are also relevant to the choice of an appropriate therapeutic strategy. Treatment is always individually tailored according to the characteristics of both patients and lesions. This review focuses on the therapeutic approaches to AK and illustrates the currently available home-based and physician-managed treatments.

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Section: Home-based Treatmentsmentioning

confidence: 99%

A Review of Existing Therapies for Actinic Keratosis: Current Status and Future Directions

et al. 2022

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“…While cryosurgery is intended to treat isolated or a few lesions, topical treatments, such as 5-FU, are more efficacious to treat both clinical and subclinical AKs [ 2 , 12 , 13 ]. However, 5-FU is associated with frequent LSRs, and patients with a greater number of AKs at baseline may be predisposed to severe LSRs [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Refusal of Retreatment With Topical 5-Fluorouracil Among Patients With Actinic Keratosis: Qualitative Analysis

Singh¹,

McCain²,

Grada³

et al. 2023

JMIR Dermatol

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Background Actinic keratosis (AK) is a common premalignant skin lesion, and topical 5-fluorouracil (5-FU) is commonly used in field-directed therapy. However, 5-FU is associated with frequent local skin reactions. Objective This study aimed to qualitatively assess experiences among patients with AK who refuse retreatment with 5-FU. Methods Semistructured interviews were conducted with 10 adult participants who had received treatment with 5-FU for AK between January 1, 2017, and January 1, 2020, and refused future treatment with 5-FU. Results were analyzed using qualitative research methods. Results Although most participants had low concern upon having received a diagnosis of AK, most felt that treatment is very important. When initiating treatment with 5-FU, most cited recommendation by their health care professionals as the primary motivator and initially had low concern regarding treatment. The side effects associated with treatment were physically and psychosocially burdensome for most participants and led to temporary lifestyle adjustments. After treatment, most did not believe that their health care provider prepared them for treatment or were unsure. While half of the participants felt that 5-FU helped treat AKs, half were either unsure, due to premature discontinuation, or did not think that 5-FU treated their AKs. Conclusions 5-FU is one of the most commonly prescribed treatments for AKs, yet most patients experienced both a physical and psychosocial burden with the treatment. Inability to assess efficacy due to premature discontinuation secondary to 5-FU–related reactions is common, and shared decision-making, navigating treatment options, and taking into account patient preferences may be critical to help assure better adherence and outcomes. Although our study was limited by input from participants who refused future treatment with 5-FU, most stated that they would still continue to seek treatment for AKs in the future and would consider other topical treatments, especially if associated with a milder tolerability profile.

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“…Current topical treatments used for AKs, including fluorouracil and imiquimod, can cause severe LSRs (necrosis), prolonged patient discomfort, and systemic effects, which limit their real-world effectiveness. 15 Furthermore, diclofenac, fluorouracil, and imiquimod require a long duration of application from weeks to months. [16][17][18] Tirbanibulin is, therefore, favorable because of duration of treatment, safety profile, and ease of use.…”

Section: Relevance To Patient Care and Clinical Practicementioning

confidence: 99%

1% Tirbanibulin Ointment for the Treatment of Actinic Keratoses

Dao

Sahni

et al. 2021

Ann Pharmacother

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Objective Actinic keratoses (AKs) are cutaneous lesions that arise in sun-damaged skin. AKs may transform into squamous cell carcinoma in situ. Tirbanibulin 1% ointment is a new topical treatment for AKs, recently approved by the Food and Drug Administration. Data Sources The PubMed database was searched for articles published from 1960 to March 31, 2021, using the keywords tirbanibulin and Klisyri. Data Extraction Phase 2 and phase 3 clinical trials were reviewed. Data Synthesis In phase 2 clinical trials, 43% of patients treated with tirbanibulin experienced complete clearance by day 57 (43% [95% CI = 32, 54]). Across two phase 3 clinical trials (pooled data), complete (100%) clearance occurred in 49% of patients in tirbanibulin groups and in only 9% of the vehicle groups (difference, 41% points; 95% CI = 35 to 47; P < 0.001). Although no comparative studies are available, tirbanibulin is applied for a shorter duration (5 days) compared with diclofenac 3% gel, fluorouracil 5% cream, and imiquimod 3.75% cream. Adverse events were mild and included pruritus, application site pain, and local skin reactions. Systemic adverse events such as necrosis and angioedema, observed with other AK treatments such as fluorouracil and imiquimod, were not observed with tirbanibulin, thus giving tirbanibulin a favorable safety profile. Relevance to Patient Care and Clinical Practice Tirbanibulin effectively reduces AK burden and recurrence and has a favorable safety profile with mild adverse events. In comparison, imiquimod, 5-flourouracil, and diclofenac can result in necrosis, angioedema, and arthralgias. Conclusion With a favorable safety profile and short regimen, tirbanibulin is an efficacious treatment for clinicians to utilize in their treatment toolbox when treating AKs on the face and scalp.

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Patient assessment of 5-fluorouracil and imiquimod for the treatment of actinic keratoses: a retrospective study of real-world effectiveness

Cited by 7 publications

References 14 publications

A Review of Existing Therapies for Actinic Keratosis: Current Status and Future Directions

A Review of Existing Therapies for Actinic Keratosis: Current Status and Future Directions

Refusal of Retreatment With Topical 5-Fluorouracil Among Patients With Actinic Keratosis: Qualitative Analysis

1% Tirbanibulin Ointment for the Treatment of Actinic Keratoses

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