Systematic Literature Review and Network Meta-analysis of the Efficacy and Acceptability of Interventions in Actinic Keratoses

• Published in: Acta dermato-venereologica 2021-01, Vol.101 (1), p.adv00358-adv00358
• Main Authors: Ezzedine, Khaled, Painchault, Caroline, Brignone, Melanie
• Format: Article
• Language: English
• Subjects: actinic keratosis; Clinical Report; field-directed intervention; network meta-analysis; systematic literature review
• ISSN: 1651-2057; 0001-5555; 1651-2057
• DOI: 10.2340/00015555-3690

A systematic literature review was conducted to identify and qualitatively assess randomized controlled trials in immunocompetent patients ≥ 18 years with head- region lesions of actinic keratoses who were treated with field-directed, lesion-directed and other therapies. Network meta-analysis was used to quantitatively evaluate field-directed therapies (5-fluorouracil formulations, diclofenac sodium, imiquimod, ingenol mebutate, 5-aminolevulinic acid or methyl aminolevulinate plus photodynamic therapy) using complete clearance or partial clearance of actinic keratoses lesions, and adverse event-related withdrawals as a proxy of acceptability. Of 2,863 references identified, 75 trials reported in 151 publications were included. In summary, comparative network meta-analysis evaluation showed that 5-fluorouracil formulations were the most efficacious interventions examined. 5-fluorouracil 4%, which was recently approved, showed a comparable efficacy profile to 5-fluorouracil 5%, and had satisfactory acceptability outcomes.