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Comparative effectiveness of treatment of actinic keratosis with topical fluorouracil and imiquimod in the prevention of keratinocyte carcinoma: A cohort study - 14/03/19

Doi : 10.1016/j.jaad.2018.11.024 
Romain Neugebauer, PhD a, Katherine A. Su, MD b, c, Zheng Zhu, MS a, Monica Sokil, BA, BS a, Mary-Margaret Chren, MD d, Gary D. Friedman, MD, MS a, Maryam M. Asgari, MD, MPH a, b, c,
a Division of Research, Kaiser Permanente Northern California, Oakland, California 
b Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 
c Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts 
d Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee 

Correspondence to: Maryam M. Asgari, MD, MPH, Department of Dermatology, Massachusetts General Hospital, 50 Staniford St, Suite 270, Boston, MA 02114.Department of DermatologyMassachusetts General Hospital50 Staniford St, Suite 270BostonMA02114

Abstract

Background

The effectiveness of 5-fluorouracil compared with that of imiquimod for preventing keratinocyte carcinoma is unknown.

Objective

To compare the effectiveness of 5-fluorouracil and that of imiquimod in preventing keratinocyte carcinoma in a real-world practice setting.

Methods

We identified 5700 subjects who filled prescriptions for 5-fluorouracil or imiquimod for treatment of actinic keratosis in 2007. An intention-to-treat analysis controlling for potential confounding variables was used to calculate 2- and 5-year cumulative risk differences for subsequent keratinocyte carcinoma overall and in field-treated areas.

Results

5-Fluorouracil was associated with a statistically significant decreased risk of any keratinocyte carcinoma compared with imiquimod (adjusted hazard ratio [aHR], 0.86; 95% confidence interval [CI], 0.76-0.97), but there were no significant differences in risk by tumor subtype (for squamous cell carcinoma: aHR, 0.89; 95% CI, 0.74-1.07; for basal cell carcinoma: aHR, 0.87; 95% CI, 0.74-1.03) or site-specific keratinocyte carcinoma (aHR, 0.96; 95% CI, 0.81-1.14). There were no significant differences in 2- or 5-year cumulative risk of keratinocyte carcinoma among those treated with 5-fluorouracil versus with imiquimod.

Limitations

Generalizability to other practice settings may be limited.

Conclusions

Whereas 5-fluorouracil was more effective in reducing keratinocyte carcinoma risk overall, we found no differences in the short- or long-term risk of subsequent site-specific keratinocyte carcinoma in a real-world practice setting.

Le texte complet de cet article est disponible en PDF.

Key words : actinic keratosis, basal cell carcinoma, comparative effectiveness, 5-fluorouracil, imiquimod, keratinocyte carcinoma, skin cancer, squamous cell carcinoma

Abbreviations used : aHR, AK, BCC, CI, 5-FU, HR, ICD-9, IPW, KC, KPNC, RD, SCC


Plan


 Dr Neugebauer and Dr Su are cofirst authors and contributed equally to this work.
 Funding sources: This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants R03 AR065014 and K24 AR069760 to Dr Asgari).
 Disclosure: Dr Asgari has research contracts with Pfizer, Inc, and Valeant Pharmaceuticals that are not relevant to the contents of this article.
 Reprints not available from the authors.


© 2018  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 80 - N° 4

P. 998-1005 - avril 2019 Retour au numéro
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