A real-world, community-based cohort study comparing the effectiveness of topical fluorouracil versus topical imiquimod for the treatment of actinic keratosis - 14/03/18
Abstract |
Background |
The most widely used topical agents for the field-based treatment of multiple actinic keratoses (AKs) are 5-fluorouracil and imiquimod, but their comparative effectiveness has not been assessed in a real-world setting.
Objective |
We compared the effectiveness of 5-fluorouracil and imiquimod in reducing risk for subsequent AKs in a large, integrated health care delivery system in northern California.
Methods |
In this cohort study, we identified adult health plan members who had an AK diagnosed in 2007 and who subsequently filled a prescription for 5-fluorouracil or imiquimod (N = 5700). We followed subjects for subsequent AKs identified by the International Classification of Diseases codes and estimated the 2-year (short-term) and 5-year (long-term) differences in cumulative risk while controlling for potential confounding by pretreatment variables.
Results |
5-Fluorouracil reduced the short-term incidence of subsequent AKs (cumulative risk difference -4.54% [95% confidence interval, -7.91% to -1.17%]), but there was no statistically significant evidence of a long-term decreased risk (cumulative risk difference -1.43% [95% confidence interval, -3.43% to 0.05%]) compared with that with imiquimod.
Limitations |
This is a retrospective study with limited ascertainment of all relevant potential confounding variables.
Conclusion |
We found that 5-fluorouracil appeared to be significantly more effective than imiquimod in the short-term, but not long-term, prevention of subsequent AKs.
Le texte complet de cet article est disponible en PDF.Key words : actinic keratosis, basal cell carcinoma, comparative effectiveness, keratinocyte carcinoma, skin cancer, squamous cell carcinoma
Abbreviations used : AK, CI, 5-FU, ICD-9, Imq, IP, IPW, KC, KPNC, PS
Plan
| Funding sources: Supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants R03AR064014 and K24AR069760 to MA). |
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| Disclosure: Dr Asgari has research contracts with Pfizer and Valeant Pharmaceuticals that are not relevant to the contents of this manuscript. Dr Neugebauer, Ms Levandoski, Ms Zhu, Ms Sokil, Dr Chren, and Dr Friedman have no conflicts of interest to disclosed. |
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| Reprints not available from the authors. |
Vol 78 - N° 4
P. 710-716 - avril 2018 Retour au numéro
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