Original articleA real-world, community-based cohort study comparing the effectiveness of topical fluorouracil versus topical imiquimod for the treatment of actinic keratosis
Section snippets
Materials and methods
We performed a retrospective longitudinal cohort study of all Kaiser Permanente Northern California (KPNC) members with a diagnosed AK who filled prescriptions for 5-FU (n = 5062) or Imq (n = 638) in 2007. Cohort members were followed for subsequent AK diagnosis.
Results
Of the 5700 patients in the cohort, 5062 were exposed to 5-FU and 638 were exposed to Imq. In the majority (n = 4946), a subsequent AK was diagnosed during follow-up. Of the 754 patients with no subsequent AK diagnosis, 289 were censored due to a membership gap of greater than 3 month, 100 were censored due to death, and 365 were followed through to the end of the study period. In total, 281 patients had no subsequent AK diagnosis before 2 years, and 441 had no subsequent AK diagnosis before
Discussion
In this large cohort study based in a real-world HMO setting with comprehensive integrated health care delivery, we have shown that 5-FU may be more effective than Imq in preventing subsequent AKs in the short term, but we did not find statistically significant evidence of a difference in the long term.
To our knowledge, this is the first study to compare the effectiveness of 5-FU and Imq in preventing subsequent AKs in a real-world setting. Only 2 small randomized trials have directly compared
References (20)
- et al.
The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology
J Am Acad Dermatol
(2006) - et al.
The increased risk of skin cancer is persistent after discontinuation of psoralen+ultraviolet A: a cohort study
J Invest Dermatol
(2003) - et al.
Photosensitizing agents and the risk of non-melanoma skin cancer: a population-based case-control study
J Invest Dermatol
(2013) - et al.
Review of actinic keratosis. Part I: etiology, epidemiology and clinical presentation
J Drugs Dermatol
(2010) Epidemiology of actinic keratoses and squamous cell carcinoma
J Am Acad Dermatol
(2000)- et al.
Frequency and cost of actinic keratosis treatment
Dermatol Surg
(2006) - et al.
Interventions for actinic keratoses
Cochrane Database Syst Rev
(2012) - et al.
Current perspective on actinic keratosis: a review
Br J Dermatol
(August 2016) - et al.
HIV infection status, immunodeficiency, and the incidence of non-melanoma skin cancer
J Natl Cancer Inst
(2013) - et al.
Non-Hodgkin’s lymphomas, chronic lymphocytic leukaemias and skin cancers
Br J Cancer
(1996)
Cited by (12)
Field cancerization: Treatment
2020, Journal of the American Academy of DermatologyCitation Excerpt :Key points Field-directed therapy reduces actinic keratosis (AK) burden as well as the number of new cutaneous squamous cell carcinomas (CSCCs).3-6 Although there is substantial literature to support various field therapies, comparing different modalities is difficult because of heterogenous study endpoints and the lack of standardized, objective methods for assessing field disease.
Topical and Intralesional Chemotherapeutic Agents
2020, Comprehensive Dermatologic Drug Therapy, Fourth EditionTrends in the treatment and prevention of keratinocyte carcinoma (non-melanoma skin cancer)
2019, Current Opinion in PharmacologyCitation Excerpt :Local treatment options have not markedly changed in the last few years and imiquimod, ingenolmebutate, diclofenac-hyaluronic acid, and 5-fluorouracil, as well as photodynamic therapy (PDT) are used for early and superficial forms. Recently, 5-fluorouracil was shown to be more effective than imiquimod for preventing subsequent AK, although only in the short-term [21]. PDT is a non-invasive and widely used approved treatment for AK, although the pain involved and the need for specialized equipment limits its use.
Comparative effectiveness of treatment of actinic keratosis with topical fluorouracil and imiquimod in the prevention of keratinocyte carcinoma: A cohort study
2019, Journal of the American Academy of DermatologyCitation Excerpt :KPNC maintains a computerized record system with detailed information on members’ demographic characteristics; clinical visits; pharmacy dispensed medications; laboratory, pathology, and radiology results; and other medical services. The study cohort has been described previously13 and consists of adult KPNC members in whom AK was diagnosed (ICD-9 code 702.0) between January 1, 2007, and December 31, 2007, and who received subsequent topical AK field treatment with 5-FU or imiquimod (N = 8556) (Fig 1). The year 2007 was selected because imiquimod was not available before 2007 and doing so allowed for electronic review of all outpatient ambulatory notes, which facilitated abstraction of information on treatment indication, anatomic site of application, and site of subsequent KC.
Pharmacological Agents Used in the Prevention and Treatment of Actinic Keratosis: A Review
2023, International Journal of Molecular Sciences
Funding sources: Supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants R03AR064014 and K24AR069760 to MA).
Disclosure: Dr Asgari has research contracts with Pfizer and Valeant Pharmaceuticals that are not relevant to the contents of this manuscript. Dr Neugebauer, Ms Levandoski, Ms Zhu, Ms Sokil, Dr Chren, and Dr Friedman have no conflicts of interest to disclosed.
Reprints not available from the authors.