Comparative effectiveness of treatment of actinic keratosis with topical fluorouracil and imiquimod in the prevention of keratinocyte carcinoma: A cohort study - 14/03/19
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. |
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| 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). |
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| Disclosure: Dr Asgari has research contracts with Pfizer, Inc, and Valeant Pharmaceuticals that are not relevant to the contents of this article. |
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| Reprints not available from the authors. |
Vol 80 - N° 4
P. 998-1005 - avril 2019 Retour au numéro
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