Long-term efficacy highest for PDT with aminolevulinate for
Photodynamic therapy with aminolevulinate and imiquimod are among the treatments with good long-term efficacy for actinic keratosis, according to an investigation published in JAMA Dermatology.

“Actinic keratoses (AK) are common precancerous lesions of the skin as a consequence of lifelong exposure to UV radiation,” researchers wrote. “Multiple interventions are available for the treatment of AK in clinical practice, including topical drugs and ablative modalities.”

While many studies report the short-term efficacy of these treatments, most meta-analyses have not focused beyond 6 months after treatment. This systemic review and network meta-analysis included data from 15 clinical trials with data about 10 distinct interventions for at least 12 months of treatment.

Two reviewers independently extracted data, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance was used to assess certainty of evidence.

Photodynamic therapy with aminolevulinate (ALA-PDT), imiquimod 5%, photodynamic therapy with methyl aminolevulinate (MAL-PDT) and cryosurgery showed the greatest long-term efficacies.

The risk ratio (RR) of ALA-PDT compared with placebo was 8.06 (95% CI, 2.07-31.37; GRADE, moderate). Imiquimod 5% had a RR of 5.98 (95% CI, 2.26-15.84; GRADE, very low), MAL-PDT had a RR of 5.95 (95% CI, 1.21-29.41; GRADE, low), and cryosurgery had a RR of 4.67 (95% CI, 1.36-16.66; GRADE, very low).

Long-term efficacy in AK treatment could be clinically relevant in the prevention of invasive cutaneous squamous cell carcinoma, according to the authors, because AK is regarded as a precursor lesion.

“This study provides data that might contribute to an evidence-based framework to guide the selection of interventions for AK with proven long-term efficacy and sustained AK clearance,” the authors wrote.

Source: https://jamanetwork.com/journals/jamadermatology/article-abstract/2782523