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Berman B, Armstrong A, Lebwohl M, Grada A, Bhatia N, Patel VA, Rigel D, Del Rosso J, Schlesinger T, Kircik L, Salem R, Narayanan S, Kasujee I. Developing a questionnaire for assessing clinician- and patient-reported outcomes in actinic keratosis: Results from an expert panel. JAAD Int 2024; 16:192-198. [PMID: 39040844 PMCID: PMC11262182 DOI: 10.1016/j.jdin.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 07/24/2024] Open
Abstract
Background Current assessments on topical treatment attributes in actinic keratosis (AK) do not evaluate safety, effectiveness, and satisfaction from both clinician and patient perspectives, creating an unmet need for more comprehensive AK-specific measures that fully capture the patient experience. Objective To develop an actinic keratosis-specific expert panel questionnaire (AK-EPQ) of patient-reported outcomes and clinician-reported outcomes for use in research studies. Methods Using interviews of patients with AK and targeted literature reviews, a 9-person consensus panel of dermatologists with expertise in AK treatment was convened to develop the AK-EPQ to assess AK-specific patient-reported outcomes and clinician-reported outcomes. Results Nine expert advisers achieved consensus on 11 AK-EPQ items that encompass patient and clinician perspectives of treatment-related local skin reactions, clinical and cosmetic outcomes associated with AK, and satisfaction with treatment; the AK-EPQ will be first implemented in the Patient-Reported Outcomes for Actinic Keratosis study (NCT05260073). Limitations The AK-EPQ does not directly measure quality of life, although it can be used with validated quality of life instruments. Conclusion The newly developed AK-EPQ elicits insights into the patient and clinician experience with AK treatments. Comparative probing of these perspectives may help optimize precision medicine in AK treatment.
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Affiliation(s)
- Brian Berman
- University of Miami Miller School of Medicine, Miami, Florida
| | - April Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mark Lebwohl
- Mount Sinai Icahn School of Medicine, New York, New York
| | - Ayman Grada
- Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio
| | - Neal Bhatia
- Therapeutics Clinical Research, San Diego, California
| | - Vishal A. Patel
- George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - Darrell Rigel
- Mount Sinai Icahn School of Medicine, New York, New York
| | | | - Todd Schlesinger
- Clinical Research Center of the Carolinas, Charleston, South Carolina
| | - Leon Kircik
- Mount Sinai Icahn School of Medicine, New York, New York
| | - Raidah Salem
- Medical Affairs, Almirall, LLC, Malvern, Pennsylvania
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Dosik J, Cutler DL, Fang J, Padullés L. Contact Sensitization and Phototoxic and Photoallergic Potential of Tirbanibulin 1% Ointment in Healthy Volunteers. JID INNOVATIONS 2022; 3:100170. [PMID: 36699198 PMCID: PMC9868847 DOI: 10.1016/j.xjidi.2022.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
Tirbanibulin 1% ointment is approved for the topical treatment of actinic keratosis, applied once daily for 5 days. Three phase 1 randomized, single-center, controlled, within-subject comparison studies were conducted to evaluate the sensitization (KX01-AK-006), phototoxic (KX01-AK-008), and photoallergic (KX01-AK-009) potential of tirbanibulin 1% ointment in healthy adults. In KX01-AK-006 and KX01-AK-009, subjects received repeated applications of tirbanibulin or vehicle for induction (followed by irradiation in KX01-AK-009) and an additional application for the challenge on naïve sites. In KX01-AK-008, subjects received single applications, followed by irradiation. Sensitization was defined as a reaction scoring 3 at naïve sites, recurring at rechallenge. Photoallergy was assessed based on the dermal response of erythema + edema at naïve sites. Phototoxicity was assessed based on the average dermal response score (days 3‒4). Adverse events were collected. In KX01-AK-006, none of the 229 subjects scored 3 at naïve sites. In KX01-AK-008, none of the 31 subjects developed edema, not meeting the criteria for phototoxicity. In KX01-AK-009, none of the 59 subjects showed reactions compatible with photoallergy. Mild-to-moderate contact irritations were reported. The evidence provided by these phase 1 studies showed that tirbanibulin 1% ointment lacks sensitization and phototoxic or photoallergic potential, and supports the safety of its topical application.
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Affiliation(s)
- Jonathan Dosik
- TKL Research, Fair Lawn, New Jersey, USA,Correspondence: Jonathan Dosik, TKL Research, One Promenade Boulevard, Suite 1201, Fair Lawn, New Jersey 07410, USA.
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Sola-Ortigosa J, Muñoz-Santos C, Otzet-Gramunt I, Masat-Ticó T, Isidro-Ortega J, Guilabert A. The Usefulness of Teledermatology in Monitoring the Efficacy and Safety of a Topical Treatment for Actinic Keratosis. J Invest Dermatol 2021; 141:1837-1839.e12. [PMID: 33453263 DOI: 10.1016/j.jid.2020.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/14/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Joaquin Sola-Ortigosa
- Department of Dermatology, Fundació Privada Hospital Asil de Granollers, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
| | - Carlos Muñoz-Santos
- Department of Dermatology, Fundació Privada Hospital Asil de Granollers, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Isabel Otzet-Gramunt
- Primary Care Physicians, Members of the Grup d'Estudi de Teledermatologia del Vallès Oriental, Barcelona, Spain
| | - Teresa Masat-Ticó
- Primary Care Physicians, Members of the Grup d'Estudi de Teledermatologia del Vallès Oriental, Barcelona, Spain
| | - Joan Isidro-Ortega
- Primary Care Physicians, Members of the Grup d'Estudi de Teledermatologia del Vallès Oriental, Barcelona, Spain
| | - Antonio Guilabert
- Department of Dermatology, Fundació Privada Hospital Asil de Granollers, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
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Gameiro L, Tovo LFR, Sanches Júnior JA, Aprahamian I. Treatment of actinic keratoses and cancerization field of the face and scalp with 0.015% ingenol mebutate gel in Brazilian individuals: safety, tolerability and patients' perspectives. An Bras Dermatol 2019; 94:313-319. [PMID: 31365660 PMCID: PMC6668952 DOI: 10.1590/abd1806-4841.20197938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/25/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Actinic keratosis (AK) represents a risk of progression to squamous cell carcinoma. Ingenol mebutate gel is a novel therapeutic option for field-directed treatment. OBJECTIVES To evaluate the safety, tolerability and patients' perspectives, related to the therapeutic success of managing AKs on the face and scalp with ingenol mebutate gel in Brazilian individuals. METHODS This was an observational, retrospective and descriptive study of 68 areas of actinic keratosis on the face and scalp treated with Ingenol mebutate gel involving a total of 37 patients. The drug was applied for three consecutive days on an area of of 25 cm2 and documentation was performed on baseline and days 4, 8, 15, 60 and 180. On day 4, the composite local skin reaction score was calculated. At the end, a questionnaire was applied to evaluate patients' perspectives about the treatment. RESULTS Adherence was 100%, no serious adverse events were recorded and the mean composite local skin reaction score (standard deviation) was 8.61±4.22. The treatment was considered optimum by 75.68% of the patients. STUDY LIMITATIONS Calculation of composite local skin reaction score performed only on the fourth day. CONCLUSIONS Treatment with ingenol mebutate gel was considered safe and tolerable in Brazilian subjects. Patients had a maximum adherence rate and a great improvement in self-esteem. The results of this research reproduce the findings of the literature.
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Affiliation(s)
- Luiz Gameiro
- Department of Internal Medicine, Faculdade de Medicina de
Jundiaí, Jundiaí (SP), Brazil
| | | | | | - Ivan Aprahamian
- Department of Internal Medicine, Faculdade de Medicina de
Jundiaí, Jundiaí (SP), Brazil
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Roediger A, Wilsdon T, Haderi A, Pendleton K, Azais B. Competition between on-patent medicines in Europe. Health Policy 2019; 123:652-660. [PMID: 31176459 DOI: 10.1016/j.healthpol.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/24/2019] [Accepted: 05/08/2019] [Indexed: 12/27/2022]
Abstract
There is widespread concern regarding the high price of innovative medicines and their impact on the sustainability of healthcare systems. However, the debate rarely accounts for the evolution of prices over the lifetime of the medicine and the impact of competitive forces. This article uses the experience of hepatitis C (HCV), during the years 2010-2017 to examine the impact of in-class competition and implications for policies that enable competition. To study the HCV market, we focused on European countries and applied a two-step approach involving a comprehensive literature review and an analysis of monthly sales data in US$ across seven European countries from July 2011 until July 2017. We find that competition to address the unmet medical need has led to significant treatment improvements to the benefit of patients, payers and the wider healthcare system and society. Competitive launches have led to innovative agreements, lowering the cost per treatment and improving patient access to treatment. For innovators, intense competition does not only impact the price set and their market share but in many cases shortens the economic life of the product to only a fraction of the patented period. This has an impact on future research decisions, focusing efforts on areas where unmet need is greatest. Sustainable innovation requires a well-balanced policy framework that provides the appropriate incentives and encourages competition.
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Calzavara-Pinton P, Tanova N, Hamon P. Evaluation of the treatment costs and duration of topical treatments for multiple actinic keratosis based on the area of the cancerization field and not on the number of lesions. J Eur Acad Dermatol Venereol 2018; 33:312-317. [DOI: 10.1111/jdv.15269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022]
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Neri L, Peris K, Longo C, Calvieri S, Frascione P, Parodi A, Eibenschuz L, Bottoni U, Pellacani G. Physician-patient communication and patient-reported outcomes in the actinic keratosis treatment adherence initiative (AK-TRAIN): a multicenter, prospective, real-life study of treatment satisfaction, quality of life and adherence to topical field-directed therapy for the treatment of actinic keratosis in Italy. J Eur Acad Dermatol Venereol 2018; 33:93-107. [PMID: 29920789 DOI: 10.1111/jdv.15142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 05/22/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Patients with multiple actinic keratoses (AKs) should be treated with field-directed therapy. Such treatments challenge patients' adherence due to out-of-pocket costs, length of treatment and severity of local skin reactions (LSRs). Effective physician-patient communication (PPC) may buffer therapy-related distress, thus improving quality of life, treatment satisfaction and adherence. OBJECTIVES We evaluated the interplay between PPC, LSR intensity (safety) and lesion clearance rates (effectiveness) on treatment satisfaction, quality of life and treatment adherence among patients with multiple AKs receiving topical field-directed therapies. METHODS In this observational, multicentre, longitudinal, cohort study, we included 1136 adult patients with discrete, clinically detectable, visible, multiple (three or more lesions in a 25 cm2 area), Grade I/II AKs, for whom the attending dermatologist has prescribed treatment with a topical field-directed therapy. We matched self-reported data and medical information recorded by dermatologists in standard clinical forms. Patients were followed up at two time points (T1: 8 days; T2: 25-30 days) RESULTS: Most patients were elderly, married, men with poor socio-economic status and multiple lesions of the scalp or face. The majority (n = 961) had a prescription of ingenol mebutate (IMB) and 175 received either diclofenac 3% in hyaluronic acid (DHA) or imiquimod 5% (IMQ). Clearance rate at 1 month was 84%. Most patients felt very supported (n = 819, 73%) and rated dermatologist's explanations very clear (n = 608, 54%). Treatment satisfaction (effectiveness and convenience scales) increased along the follow-up, especially for those on IMB (Δpre-post = -4.00; other: Δpre-post = -0.25; interaction P < 0.001). Communication clarity was associated with higher treatment satisfaction scores (β = 0.4-0.6, P < 0.01) and lower risk of non-adherence among IMB patients (risk difference: 16%, P < 0.01). CONCLUSION Communication clarity was associated with patient-reported outcomes and adherence beyond AK-related clinical parameters. Our study questions the current episodic approach to AK management and provides the rationale to develop chronic care models fostering patients' engagement and treatment alliance.
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Affiliation(s)
- L Neri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - K Peris
- Department of Dermatology, Catholic University, Rome, Italy
| | - C Longo
- Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - S Calvieri
- Department of Internal Medicine and Clinical Sciences, University of Rome 'La Sapienza', Rome, Italy
| | - P Frascione
- Department of Dermatologic Oncology, Regina Elena National Institute for Cancer Treatment and Research, Rome, Italy
| | - A Parodi
- Division of Dermatology, Università di Genova, DISEM, Genova, Italy
| | - L Eibenschuz
- Department of Dermatologic Oncology, Santa Maria and San Gallicano Dermatologic Institute, Istituto Fisioterapici Ospidalieri (IFO) of Rome, Rome, Italy
| | - U Bottoni
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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Successful Treatment of Actinic Keratosis with Kanuka Honey. Case Rep Dermatol Med 2018; 2018:4628971. [PMID: 29955399 PMCID: PMC6000848 DOI: 10.1155/2018/4628971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/06/2018] [Indexed: 11/27/2022] Open
Abstract
Actinic keratoses form as rough, scaly plaques on sun-exposed areas; they can be an important step in premalignant progression to squamous cell cancer of the skin. Currently, pharmacological treatments consist of topical immunomodulatory agents with poor side effect profiles. Use of honey has been common in both ancient and modern medicine, where it is now a key therapy in the management of wound healing. In vitro studies show the New Zealand native Kanuka honey to have immunomodulatory and antimitotic effects, with recent evidence suggesting efficacy of topical application in a variety of dermatological contexts, including rosacea and psoriasis. Here, we present a case report of a 66-year-old gentleman with an actinic keratosis on his hand, which had been present for years. Regular application of Kanuka honey over three months resulted in remission immediately following the treatment period with no signs of recurrence at nine months.
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Longo I, Serra-Guillén C. Quality of Life, Behaviour and Attitudes towards Actinic Keratosis in Spain: The PIQA Study. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Longo I, Serra-Guillén C. Quality of Life, Behaviour and Attitudes towards Actinic Keratosis in Spain: The PIQA Study. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:331-339. [PMID: 29477269 DOI: 10.1016/j.ad.2018.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study was aimed to examine patients' knowledge, behaviours and attitudes regarding actinic keratosis (AK) lesions and the impact of the disease on patients' quality of life (QoL). METHODS Observational study of patients with AK lesions in Spain. QoL was evaluated with the validated version of Spanish AKQoL questionnaire. Skin self-examination, sun-exposure, habits and attitudes towards AK's treatment were recorded using different questionnaires. The adherence was assessed by means of the Morisky-Green test. Among other variables, QoL and adherence to treatment were compared by using Pearson's χ2 test and one-way ANOVA tests. Inferential analysis regarding such factors and length of treatment were also performed. RESULTS A total of 1240 patients (73.6 [10.5] years old) were recruited. Overall, patients that showed higher levels of concern were also showed a higher impairment on QoL. AK had greater effects on women's QoL and those who performed skin self-examination, think that AK is a disease and/or believe that moisturizers can prevent skin aging (P<.05). Adherence and length of treatment were strongly related, since patients with treatments intended for <1week were more likely to show good adherence and complete remission of AK (Odds Ratio [95%CI]: 6.25 [4.55-8.33] and 2.63 [1.96-3.45]), respectively). CONCLUSIONS Concerns due to AK are mainly related to sex and to the consideration of AK as a disease. More concerned patients tend to have lower QoL and good adherence to treatment. Short length of treatment was associated with better adherence and complete remission of AK lesions.
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Affiliation(s)
- I Longo
- Hospital Central de la Defensa Gómez Ulla, Madrid, España
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11
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Stockfleth E, Harwood CA, Serra-Guillén C, Larsson T, Østerdal ML, Skov T. Phase IV head-to-head randomized controlled trial comparing ingenol mebutate 0·015% gel with diclofenac sodium 3% gel for the treatment of actinic keratosis on the face or scalp. Br J Dermatol 2018; 178:433-442. [PMID: 29030864 DOI: 10.1111/bjd.16048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ingenol mebutate (IngMeb) and diclofenac sodium (DS) are approved treatments for actinic keratosis (AK). OBJECTIVES To compare the efficacy and safety of IngMeb 0·015% gel with DS 3% gel (NCT02406014). METHODS Patients with 4-8 visible, discrete AK lesions on the face/scalp in a 25 cm2 contiguous area of skin were randomized 1:1 to IngMeb once-daily for three consecutive days or DS twice-daily for 90 days. Patients with AK lesions at Week 8 following IngMeb were offered a second IngMeb course. Primary end point was complete clearance of AK lesions (AKCLEAR 100) at end of first treatment course (Week 8, IngMeb; Week 17, DS). Secondary end points included AKCLEAR 100 at end of last treatment course and Week 17; adverse events (AEs) were assessed at these time points. Patients completed treatment satisfaction questionnaires for medication (TSQM; Week 17). RESULTS AKCLEAR 100 at end of first treatment course was higher with IngMeb (34%) vs. DS (23%; P = 0·006). AKCLEAR 100 at end of last IngMeb course (53%) and Week 17 (45%) was higher than DS (both P < 0·001). The most frequent AE was application-site erythema (IngMeb 19%; DS 12%). Treatment-related AE (TRAE) duration was shorter with IngMeb. TRAE withdrawals were lower for IngMeb (2%) vs. DS (6%). TSQM scores for global satisfaction (P < 0·001) and effectiveness (P = 0·002) were higher with IngMeb, as was dosing instruction adherence (≥ 90% vs. 70%). CONCLUSIONS AKCLEAR 100, patient treatment satisfaction and effectiveness were significantly higher with IngMeb compared with DS, demonstrating superiority of IngMeb for AK treatment on face/scalp.
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Affiliation(s)
- E Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Bochum, Germany
| | - C A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, U.K
| | - C Serra-Guillén
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | | | | | - T Skov
- LEO Pharma A/S, Ballerup, Denmark
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Lain E, Skov T, Hall A. Pharmacokinetics and Safety of Ingenol Disoxate Gel Administered Under Maximum-Use Conditions to Patients With Actinic Keratosis. Clin Drug Investig 2017; 38:249-257. [PMID: 29204958 DOI: 10.1007/s40261-017-0608-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Ingenol disoxate (LEO 43204) is a field therapy in development for the treatment of actinic keratosis (AK) on areas between 25 and 250 cm2. We evaluated the systemic exposure and safety of ingenol disoxate under maximum-use conditions. METHODS This was a phase I, open-label, non-randomized, multicenter trial. Patients ≥ 18 years of age with ≥ 15 clinically typical, visible, discrete AK lesions in a treatment area on the full face or approximately 250 cm2 on the arm or scalp were treated once-daily for 3 consecutive days with ingenol disoxate 0.018, 0.1, or 0.037% gel, respectively. RESULTS The trial included 58 patients. Median age (range) of patients was 68 years (42-89) [face, N = 18], 66 years (43-88) [arm, N = 21], and 67 years (37-83) [scalp, N = 19]. The highest quantifiable ingenol disoxate level was observed in the arm group (0.33 nM, area under the concentration-time curve from time zero to the last data point [AUCtlast] 3.12 nM·h). Mean composite local skin response scores peaked at Day 4 and declined towards baseline by Day 15 in all treatment groups. Most adverse events (AEs) were of mild or moderate intensity; the most common treatment-related AEs were application-site pain (face, 88.9%; arm, 57.1%; scalp, 100.0%) and application-site pruritus (face, 50.0%; arm, 52.4%; scalp, 42.1%). CONCLUSION Very low systemic exposure to ingenol disoxate was observed when applied to the face, arm, or scalp in patients with AK under maximum-use conditions. No new safety signals were identified. TRIAL REGISTRATION NCT02424305.
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Affiliation(s)
- Edward Lain
- Austin Institute for Clinical Research, 302 N Heatherwilde Boulevard #200, Pflugerville, TX, 78660, USA.
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13
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Goldenberg G. Treatment considerations in actinic keratosis. J Eur Acad Dermatol Venereol 2017; 31 Suppl 2:12-16. [PMID: 28263018 DOI: 10.1111/jdv.14152] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/31/2017] [Indexed: 11/29/2022]
Abstract
The chronic skin condition actinic keratosis (AK) is characterized by the formation of keratotic lesions of variable thickness that are poorly delimited. AK occurs on areas of the skin that have had long-term exposure to the sun or UV radiation. Although AKs may regress, they usually persist and can progress to squamous cell carcinoma (SCC). Clinicians are unable to predict which AKs will progress; therefore, both clinically visible lesions and subclinical, non-visible (i.e. the entire area affected by AK/field cancerization) should be treated. AK treatment options include lesion-directed therapies that target specific AK lesions and field-directed therapies that target multiple clinical lesions and the underlying field damage. This article reviews currently available treatment options in AK, with a focus on patient-applied field therapies, and their suitability according to specific disease characteristics and patient needs. Choice of treatment in AK depends on lesion-, patient- and treatment-related factors and should be individualized. Considerations when choosing a therapy include site of application, treatment duration, surface area of application, tolerability profiles and implications on adherence. Field-directed therapies treat clinical and subclinical damage (i.e. the entire area affected by AK), achieve high rates of sustained clearance of AKs and may reduce the risk of progression to SCC. There is a clear need for field therapies with short duration of treatment and predictable, short-lived, mild local skin reactions that can be used over a large surface area. Therapies with shorter and simpler treatment courses are often associated with better adherence than treatments with longer courses. These may, therefore, represent more appropriate choices in patients for whom convenience and/or adherence are an issue.
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Affiliation(s)
- G Goldenberg
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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14
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Cerio R. The importance of patient-centred care to overcome barriers in the management of actinic keratosis. J Eur Acad Dermatol Venereol 2017; 31 Suppl 2:17-20. [PMID: 28263022 DOI: 10.1111/jdv.14091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/14/2016] [Indexed: 12/29/2022]
Abstract
Visible actinic keratosis (AK) lesions and subclinical (non-visible) sun damage in the field of cancerization are associated with risk of both non-melanoma skin cancer, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), and, more rarely, melanoma. As the incidences of AK and skin cancer are increasing, effective prevention and treatment of AK is essential to minimize disease burden and improve patient quality of life. Currently, AK lesions are often left untreated and field therapies are underused. Patient-centred care, with a focus on the patient-physician relationship, has proven cost-effective, and improved clinical outcomes and patient satisfaction in a number of therapy areas. Strategies for applying patient-centred care to AK are warranted. Existing barriers to the effective treatment of AK were identified and patient-centric strategies to overcome each barrier were discussed. Barriers to effective AK treatment include poor disease awareness (for both patient and physician), concerns associated with the cosmetic effects of treatment, treatment-related side effects, cost perceptions for lesion-directed vs field-directed therapies, and inadequate adherence, particularly with long treatment duration. Overcoming these barriers will involve patient and physician education that promotes: disease prevention and awareness; the importance of self-examination; an understanding of treatment options; and the importance of adherence to treatment. To maximize its effectiveness, education should be delivered within a patient-centric framework, where the relationship between patient and physician is built on effective communication, empathy and a feeling of partnership. Patient-centric care, including patient education, is key to overcoming the barriers associated with effective AK treatment.
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Affiliation(s)
- R Cerio
- Department of Cutaneous Medicine & Surgery, The Royal London Hospital & QMUL, Bart's Health NHS Trust, Whitechapel, London, UK
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15
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Arenberger P, Arenbergerova M. New and current preventive treatment options in actinic keratosis. J Eur Acad Dermatol Venereol 2017; 31 Suppl 5:13-17. [DOI: 10.1111/jdv.14375] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/30/2017] [Indexed: 12/13/2022]
Affiliation(s)
- P. Arenberger
- Department of Dermatovenereology; Charles University Third Faculty of Medicine; Prague Czech Republic
| | - M. Arenbergerova
- Department of Dermatovenereology; Charles University Third Faculty of Medicine; Prague Czech Republic
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McDaniel DH, Mazur C, Wortzman MS, Nelson DB. Efficacy and tolerability of a double-conjugated retinoid cream vs 1.0% retinol cream or 0.025% tretinoin cream in subjects with mild to severe photoaging. J Cosmet Dermatol 2017; 16:542-548. [PMID: 28762645 DOI: 10.1111/jocd.12381] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Topical retinoids are used to treat the visible signs of photoaging. While efficacious, they are irritating. OBJECTIVE Evaluate the effectiveness and tolerability of a double-conjugate retinoid cream (AlphaRet Overnight Cream; AHA-Ret) in improving visible signs of photoaging vs 1.0% retinol or 0.025% tretinoin. METHODS A 12-week, split-face, randomized trial was conducted in 48 female subjects, aged 30-65 years with mild to severe photodamage. AHA-Ret was applied to one side of the face and either retinol (n=24) or tretinoin (n=24) to the other side (PM). Expert blinded evaluation of images and Nova measurements occurred at 4, 8, and 12 weeks. Tolerability was assessed throughout the study. RESULTS Forty-seven subjects completed the study. AHA-Ret demonstrated significant reductions in average severity from baseline: Fine Lines/Wrinkles (P<.001; all time points); Erythema (P=.004, P<.0001; 8 and 12 weeks, respectively); Dyschromia (P<.0001; all time points); Skin Tone (P<.0001; all time points), and Pore Size (P=.035, P<.0001; 8 and 12 weeks, respectively). AHA-Ret induced less Erythema vs retinol at 8 (P=.008) and 12 (P<.02) weeks. AHA-Ret was noninferior to prescription tretinoin in all categories at 4 and 8 weeks, and for Fine Lines/Wrinkles, Erythema, Dyschromia, and Skin Tone at 12 weeks. Improvements in Hydration occurred at every time point with AHA-Ret only (P<.04, P<.03, P<.01). Less irritation was reported with AHA-Ret vs retinol or tretinoin. CONCLUSIONS Treatment with a double-conjugate retinoid cream demonstrated early reductions in photodamage and improvements in Hydration. AHA-Ret induced less Erythema vs retinol and was more tolerable vs retinol and tretinoin.
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Affiliation(s)
- David H McDaniel
- The McDaniel Institute of Anti-Aging Research, Virginia Beach, VA, USA
| | - Christopher Mazur
- The McDaniel Institute of Anti-Aging Research, Virginia Beach, VA, USA
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Puviani M, Galloni C, Marchetti S, Sergio Pavone P, Lovati S, Pistone G, Caputo V, Tilotta G, Scarcella G, Campione E, Diluvio L, Garofalo V, Bianchi L, Milani M. Efficacy of a film-forming medical device containing sunscreen (50+) and piroxicam 0.8% in actinic keratosis and field cancerization: a multicenter, assessor-blinded, 3 month trial. Curr Med Res Opin 2017; 33:1255-1259. [PMID: 28358282 DOI: 10.1080/03007995.2017.1313212] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Sunscreen protection in subjects with actinic keratosis (AK) is highly recommended to prevent clinical evolution of this in situ skin cancer condition. Use of topical anti-cyclooxygenase drugs such as diclofenac and piroxicam reduces the number of lesions and improves the cancerization field. A film-forming medical device in a cream formulation containing organic and inorganic sun-filters (50+ SPF) and piroxicam 0.8% (ACTX) has shown in a pilot, single-center, open trial to reduce AK lesions improving the cancerization field. AIM We evaluated in a multicenter, assessor-blinded, 3 month trial the efficacy of ACTX in AK. METHODS A total of 70 subjects with at least three AK lesions on the scalp or face were enrolled after written informed consent. Primary outcomes of the study were the clinical evolution of number of AK lesions on a target zone area and the evolution of dermoscopy features of the target lesion, assessing erythema, scaling, pigmentation, and follicular plug, using a 5 point score (from 0 to 4; maximum score: 16). Lesion count and dermoscopy score were evaluated in a blind fashion assessing digital color high definition coded images. A secondary outcome was the Investigator Global Score (IGS) of clinical evolution of the target area using a 7 point scale from -2 (significantly worse) to +4 (completely cured). IGS was evaluated in an open fashion. Subjects were instructed to apply the cream twice daily on the target area, using one finger-tip unit for the treatment of a 35 cm2 area. RESULTS All but one subject (40 men and 30 women, mean age 73 years) concluded the study period. At baseline the mean (±SD) number of AK lesions in the target area were 7.0 (5.9) with a median value of 5 and the dermoscopy score of the target lesion was 7.0 (2.3) with a median value of 7.0. ACTX treatment reduced AK lesions to 3.2 (2.9), (p = .0001; Wilcoxon Test), representing a 55% relative reduction. Dermoscopy score was reduced to 3.3 (2.6) (p = .0001) (a reduction of 53%). The IGS after ACTX treatment was +1.9 (1.1), with a median of 2.0. A total of 86% of subjects showed a clinical improvement of IGS (≥1) with a very significant/complete clearance (score +3 or +4) in 42% subjects. No change or a worsening of AK lesions was observed in 14% of the subjects. The product was well tolerated. No serious adverse events were reported during the duration of the trial. CONCLUSION In this multicenter, assessor-blinded trial, the use of a film-forming medical device with sun protection and anti-inflammatory actions was effective in reducing AK lesions and improving the dermoscopy aspect of the target lesion in 86% of treated subjects. A head-to-head trial evaluating the efficacy of this medical device in comparison with diclofenac is warranted to establish whether this therapeutic approach could offer additional advantages in term of AK lesion reduction compared to an established topical treatment. (Trial ID: ISRCTN72020277).
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Affiliation(s)
| | | | | | | | - Silvia Lovati
- c Ospedale Erba Renaldi, Menaggio ASST Valtellina e Alto Lario , Italy
| | - Giuseppe Pistone
- c Ospedale Erba Renaldi, Menaggio ASST Valtellina e Alto Lario , Italy
| | - Valentina Caputo
- d U.O.C Dermatologia, MTS-AOUP, "Paolo Giaccone" Hospital , Palermo
| | - Giovanna Tilotta
- d U.O.C Dermatologia, MTS-AOUP, "Paolo Giaccone" Hospital , Palermo
| | | | - Elena Campione
- f Clinica Dermatologica, Università Tor Vergata , Roma , Italy
| | - Laura Diluvio
- f Clinica Dermatologica, Università Tor Vergata , Roma , Italy
| | | | - Luca Bianchi
- f Clinica Dermatologica, Università Tor Vergata , Roma , Italy
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18
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Weiss J, Ulrich M, Bukhalo M, Østerdal M, Bang B, Hanke C. A seamless phase I/II dose-finding trial assessing ingenol disoxate (LEO 43204) for field treatment of actinic keratosis on the scalp. Br J Dermatol 2017; 176:1456-1464. [DOI: 10.1111/bjd.15304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 12/21/2022]
Affiliation(s)
- J. Weiss
- Gwinnett Clinical Research Center, Inc.; Snellville GA U.S.A
| | - M. Ulrich
- Collegium Medicum Berlin; Berlin Germany
| | - M. Bukhalo
- Altman Dermatology Associates; Arlington Heights IL U.S.A
| | | | - B. Bang
- LEO Pharma A/S; Ballerup Denmark
| | - C.W. Hanke
- Laser & Skin Surgery Center Indiana; Carmel IN U.S.A
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19
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Abstract
La queratosis actínica (QA) es motivo de consulta frecuente tanto en atención primaria como en atención especializada. Supone el tercer o cuarto motivo más frecuente de consulta en dermatología, llegando a representar hasta un 5-6% de los pacientes atendidos. Además, se ha observado que esta prevalencia ha ido en aumento en los últimos 10 años, en comparación con otras dermatosis, y se prevé que seguirá aumentado por la mayor esperanza de vida y por los cambios de hábitos de exposición solar acontecidos desde mediados del siglo pasado. El objetivo de este artículo es actualizar los conceptos de QA y de campo de cancerización, y exponer las herramientas terapéuticas disponibles actualmente.
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20
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Holzer G, Pinkowicz A, Radakovic S, Schmidt J, Tanew A. Randomized controlled trial comparing 35% trichloroacetic acid peel and 5-aminolaevulinic acid photodynamic therapy for treating multiple actinic keratosis. Br J Dermatol 2017; 176:1155-1161. [DOI: 10.1111/bjd.15272] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 12/17/2022]
Affiliation(s)
- G. Holzer
- Department of Dermatology; Medical University of Vienna; Vienna, SMZ Ost, 122, Langobardenstrasse 1220 Vienna Austria
- Department of Dermatology; Donauspital; SMZ Ost Vienna Vienna Austria
- Medical Research Society Vienna DC; Vienna Austria
| | - A. Pinkowicz
- Department of Dermatology; Medical University of Vienna; Vienna, SMZ Ost, 122, Langobardenstrasse 1220 Vienna Austria
| | - S. Radakovic
- Department of Dermatology; Medical University of Vienna; Vienna, SMZ Ost, 122, Langobardenstrasse 1220 Vienna Austria
| | - J.B. Schmidt
- Department of Dermatology; Medical University of Vienna; Vienna, SMZ Ost, 122, Langobardenstrasse 1220 Vienna Austria
| | - A. Tanew
- Department of Dermatology; Medical University of Vienna; Vienna, SMZ Ost, 122, Langobardenstrasse 1220 Vienna Austria
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21
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Vale SM, Hill D, Feldman SR. Pharmacoeconomic Considerations in Treating Actinic Keratosis: An Update. PHARMACOECONOMICS 2017; 35:177-190. [PMID: 27785771 DOI: 10.1007/s40273-016-0462-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Actinic keratosis is one of the most common dermatological diagnoses worldwide, especially among the elderly, fair-skinned, and immunocompromised, and is associated with a risk of transformation to skin cancer. With actinic keratosis and skin cancer prevalence increasing as the aged population expands in the US, optimizing treatment strategies may produce cost savings for the healthcare system. Since the time of our last review in 2008, investigation of the economic considerations in treating actinic keratosis has advanced. To provide an update of treatment cost effectiveness and to review factors relating to the costs of care, we conducted a systematic review of pharmacoeconomic publications since December 2008. We identified 11 pharmacoeconomic studies, with one cost-of-treatment, five cost-effectiveness, and five cost-utility analyses. Photodynamic therapy (PDT) was well tolerated and produced a favorable cosmetic outcome in most studies. Ingenol mebutate, the newest but most expensive topical field therapy, 5-fluorouracil, and PDT were the most cost-effective treatments in our review. Patient adherence to therapy and the management of adverse effects were significant contributors to treatment costs. In the US, treatment guidelines and formalized cost-effectiveness analyses for actinic keratosis are absent from the recent literature. Future pharmacoeconomic investigation will depend on up-to-date comparative efficacy data, as well as clarification of rates of, and management strategies for, adverse effects, therapeutic non-adherence, and lesion recurrence.
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Affiliation(s)
- Spencer M Vale
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Dane Hill
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA.
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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22
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Dirschka T, Gupta G, Micali G, Stockfleth E, Basset-Séguin N, Del Marmol V, Dummer R, Jemec GBE, Malvehy J, Peris K, Puig S, Stratigos AJ, Zalaudek I, Pellacani G. Real-world approach to actinic keratosis management: practical treatment algorithm for office-based dermatology. J DERMATOL TREAT 2016; 28:431-442. [DOI: 10.1080/09546634.2016.1254328] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Thomas Dirschka
- Centroderm Clinic, Wuppertal, and Faculty of Health, University of Witten-Herdecke, Witten, Germany
| | - Girish Gupta
- Department of Dermatology, Monklands Hospital, Lanarkshire, and University of Glasgow, Glasgow, UK
| | | | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | | | - Véronique Del Marmol
- Department of Dermatology, Hôpital Erasme – Université Libre de Bruxelles, Bruxelles, Belgium
| | - Reinhard Dummer
- Department of Dermatology Skin Cancer Unit, University Hospital Zürich, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde; Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Josep Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Ketty Peris
- Department of Dermatology, Catholic University of Rome, Largo A. Gemelli 8, Rome, Italy
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Alexander J. Stratigos
- First Department of Dermatology-Venereology, University of Athens Medical School, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Non-Melanoma Skin Cancer Unit, Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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23
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Jim On SC, Knudsen KM, Skov T, Lebwohl M. Relationship between severity of the local skin reactions and the rate of local skin reaction resolution in patients treated with ingenol mebutate gel. Clin Cosmet Investig Dermatol 2016; 9:211-6. [PMID: 27601928 PMCID: PMC5003522 DOI: 10.2147/ccid.s113044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Ingenol mebutate gel is a topical field treatment for actinic keratosis (AK). The treatment elicits application-site reactions in most patients. This analysis evaluated the relationship between the severity of reactions and the speed of their resolution. Methods Patients in Phase III studies were treated for AKs on the face (n=218), scalp (n=56), and trunk and extremities (n=209). All of the patients were treated with either ingenol mebutate gel 0.015% once daily for three consecutive days (face/scalp) or ingenol mebutate gel 0.05% once daily for two consecutive days (trunk/extremities). Local skin reactions (LSRs) were assessed on a 5-point scale from 0 to 4 in six categories, yielding composite scores in the range of 0 to 24. Results The composite LSR score on the day after the last application of ingenol mebutate gel was an important predictor of the speed of resolution of LSRs. The rate of resolution was greatest for AKs treated on the face, followed by the scalp, and then the trunk and extremities. All patients were expected to have minimal LSR scores for the face and scalp at 2 weeks, and for the trunk and extremities at 4 weeks. Conclusion The absolute reduction in LSR scores was proportional to the composite LSR score on the day after the last application of ingenol mebutate gel treatment. The rate of resolution for LSRs was dependent on the anatomic site treated as well as the day 4 composite score.
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Affiliation(s)
- Shelbi C Jim On
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA
| | | | - Torsten Skov
- LEO Pharma A/S, Biostatistics, Ballerup, Denmark
| | - Mark Lebwohl
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA
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24
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Boone M, Suppa M, Marneffe A, Miyamoto M, Jemec G, Del Marmol V. A new algorithm for the discrimination of actinic keratosis from normal skin and squamous cell carcinoma based on in vivo
analysis of optical properties by high-definition optical coherence tomography. J Eur Acad Dermatol Venereol 2016; 30:1714-1725. [DOI: 10.1111/jdv.13720] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/14/2016] [Indexed: 01/19/2023]
Affiliation(s)
- M.A.L.M. Boone
- Department of Dermatology; Hôpital Erasme; Université Libre de Bruxelles; Brussels Belgium
| | - M. Suppa
- Department of Dermatology; Hôpital Erasme; Université Libre de Bruxelles; Brussels Belgium
| | - A. Marneffe
- Department of Dermatology; Hôpital Erasme; Université Libre de Bruxelles; Brussels Belgium
| | - M. Miyamoto
- Department of Dermatology; Hôpital Erasme; Université Libre de Bruxelles; Brussels Belgium
| | - G.B.E. Jemec
- Department of Dermatology; Roskilde Hospital; University of Copenhagen; Copenhagen Denmark
| | - V. Del Marmol
- Department of Dermatology; Hôpital Erasme; Université Libre de Bruxelles; Brussels Belgium
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25
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Peris K, Calzavara-Pinton PG, Neri L, Girolomoni G, Malara G, Parodi A, Piaserico S, Rossi R, Pellacani G. Italian expert consensus for the management of actinic keratosis in immunocompetent patients. J Eur Acad Dermatol Venereol 2016; 30:1077-84. [PMID: 27060910 DOI: 10.1111/jdv.13648] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/15/2016] [Indexed: 12/27/2022]
Abstract
Actinic keratosis (AK) is a common skin disease which can potentially progress to invasive squamous cell carcinoma (iSCC). Given that mortality rates and health-care cost associated with iSCC are substantial, the management of AK represents an important public health issue. Several effective lesion-directed and field-directed treatments are available. Ablative procedures (e.g. cryosurgery, excision, laser ablation, curettage alone or with electrodessication) are considered cost-effective options for solitary lesions. Field-directed therapies (e.g. Ingenol Mebutate, imiquimod, PDT, 5-Fluorouracile, diclofenac 3%, 5-FU + Salicylic acid) can be used over large epidermal surfaces and are directed to treat both individual visible lesions and cancerization fields. In order to provide guidance for management choice in clinical practice, several guidelines concerning the diagnosis and treatment of AK have been published in the past decade. However, the introduction of novel therapeutic options requires continuous updates of recommendations and adaptation to national contexts. The present review summarizes the existing evidence and reports the results of a consensus workshop on the management of AK.
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Affiliation(s)
- K Peris
- Unit of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P G Calzavara-Pinton
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - L Neri
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - G Girolomoni
- Unit of Dermatology, University of Verona, Verona, Italy
| | - G Malara
- Unit of Dermatology, AO Papardo, Messina, Italy
| | - A Parodi
- Dermatology Clinic, AO San Martino, University of Genoa, Genoa, Italy
| | - S Piaserico
- Division of Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - R Rossi
- Division of Dermatology, University of Florence, Florence, Italy
| | - G Pellacani
- Unit of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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26
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Ricci F, Tambone S, Neri L, Fania L, Piccioni A, Guerriero C, Fargnoli MC, Peris K. Real-life efficacy and safety of ingenol mebutate for the treatment of actinic keratosis of the face and scalp: A single arm retrospective study. J DERMATOL TREAT 2016; 27:525-530. [DOI: 10.3109/09546634.2016.1161162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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27
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Berman B. Safety and tolerability of ingenol mebutate in the treatment of actinic keratosis. Expert Opin Drug Saf 2015; 14:1969-78. [PMID: 26524598 DOI: 10.1517/14740338.2015.1108962] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Ingenol mebutate is a topical therapeutic agent for the treatment of actinic keratosis (AK). It has a novel mode of action and has shown comparable efficacy to other topical field therapies. This article summarizes and provides perspective on the safety profile of ingenol mebutate from clinical studies of this agent. AREAS COVERED The unique mechanism of action of ingenol mebutate, the basis for a rapid clinical effect, is outlined. Safety and tolerability data, including mean composite local skin response (LSR) scores, type of LSR, and adverse events from a range of clinical studies both in healthy volunteers and patients with AK, are reviewed. The safety profile of ingenol mebutate is then compared with other agents used to treat AK lesions. EXPERT OPINION Ingenol mebutate has a dosing period of 2 - 3 days, which is short compared with other field therapies, and there is no evidence of systemic absorption. The fact that most of the LSRs observed are mild to moderate in intensity and transient, with a majority resolved within 2 weeks, makes for a favorable safety profile. Ingenol mebutate enhances the armamentarium available to the dermatologist for the treatment of AK.
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Affiliation(s)
- Brian Berman
- a Center for Clinical and Cosmetic Research , Aventura , FL , USA.,b Center for Clinical and Cosmetic Research, 2925 Aventura Boulevard, Suite 205 , Aventura , FL 33180 , USA
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