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Thin actinic keratoses on the face or scalp were 14% more likely to clear completely in patients treated with photodynamic therapy, compared with cryotherapy, in a meta-analysis of four studies including 641 patients.
Complete clearance 3 months after treatment was significantly more likely in the 2,170 actinic keratoses treated by photodynamic therapy (PDT), compared with 2,174 actinic keratoses treated by cryotherapy, Dr. Gayatri Patel and her associates reported.
The data came from randomized trials with 10 or more participants in which the PDT used topical aminolevulinic acid hydrochloride or methyl aminolevulinate hydrochloride, the most widely available PDT stabilizers in North America and Europe. Methyl aminolevulinate recently was withdrawn from the U.S. market but remains common in Europe, noted Dr. Patel of the University of California, Davis, and her associates.
The study results were published online in JAMA Dermatology (2014 Aug. 27 [doi:10.1001/jamadermatol.2014.1253]).
The results suggested that PDT works better on thinner actinic keratoses. Grade 1 (thin) actinic keratoses on the face or scalp were 86% more likely to clear by 12 weeks after PDT, compared with cryotherapy, the investigators reported.
Only one of the fours studies found higher efficacy rates for cryotherapy, compared with PDT, and more than 60% of lesions in that study were grade 2 (moderately thick, easily felt) or grade 3 (very thick and/or obvious) actinic keratoses. The other three studies in the meta-analysis excluded thicker lesions or favored thinner ones, the researchers noted.
They excluded from the meta-analysis two other studies that compared PDT with cryotherapy for actinic keratoses because of incompatible follow-up times. They reviewed 13 studies in all, including studies involving treatment of actinic keratosis with imiquimod, fluorouracil, or carbon dioxide laser, but could not meta-analyze data on these other treatments because of different outcome measures and follow-up times or lack of a comparator.
Photosensitivity, pain, erythema, and pruritus were common after PDT. Cryotherapy induced pain and pruritus, but at lower rates than did PDT. Hypopigmentation occurred in 33% of patients after cryotherapy and in 9% after PDT in one study.
Satisfaction ratings by patients and unblinded investigators tended to favor PDT over cryotherapy, perhaps because PDT may produce ancillary cosmetic improvements when treating actinic keratosis, Dr. Patel and her associates speculated.
The findings were limited by the poor quality of the studies, which were lacking double-blind design and description of randomization methods, but no sources of bias were evident, and the large number of patients and relatively similar treatment locations were strengths of the analysis, they said.
Dr. Patel reported having no financial disclosures.
On Twitter @sherryboschert
Several limitations associated with photodynamic therapy (PDT) make cryotherapy the first-line treatment choice for most practicing dermatologists, Dr. Harvey Lui commented in an article that accompanied Dr. Patel’s report.
Dr. Patel’s meta-analysis found a 14% better chance of complete clearance of actinic keratosis lesions, compared with cryotherapy, but the data are not clear enough to claim better cosmesis or patient acceptance, Dr. Lui said (JAMA Dermatol. 2014 Aug. 27 [doi:10.1001/jamadermatol.2014.1869]).
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PDT costs more in time and equipment than cryotherapy. PDT may seem simple, but achieving optimal results can require longer drug incubation times and/or light-dose fractionation. Local pain is a bigger problem with PDT that requires anticipation and management by clinicians, he said. Cryotherapy, on the other hand, requires relatively brief outpatient visits.
The future of PDT for actinic keratosis may lie in further development of a currently off-label treatment – exposure to ambient outdoor light after application of topical aminolevulinic acid, Dr. Lui suggested: "Perhaps the most tantalizing irony of daylight PDT is the specter of treating a solar-induced neoplasm with sunlight itself."
Dr. Lui is head of the department of dermatology and skin science at the University of British Columbia in Vancouver. He disclosed financial associations with Galderma, LEO Pharma, Janssen, Novartis, Valeant Pharmaceuticals, RepliCel Life Sciences, Lumen Health Technologies, and Verisante Technology.
Several limitations associated with photodynamic therapy (PDT) make cryotherapy the first-line treatment choice for most practicing dermatologists, Dr. Harvey Lui commented in an article that accompanied Dr. Patel’s report.
Dr. Patel’s meta-analysis found a 14% better chance of complete clearance of actinic keratosis lesions, compared with cryotherapy, but the data are not clear enough to claim better cosmesis or patient acceptance, Dr. Lui said (JAMA Dermatol. 2014 Aug. 27 [doi:10.1001/jamadermatol.2014.1869]).
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PDT costs more in time and equipment than cryotherapy. PDT may seem simple, but achieving optimal results can require longer drug incubation times and/or light-dose fractionation. Local pain is a bigger problem with PDT that requires anticipation and management by clinicians, he said. Cryotherapy, on the other hand, requires relatively brief outpatient visits.
The future of PDT for actinic keratosis may lie in further development of a currently off-label treatment – exposure to ambient outdoor light after application of topical aminolevulinic acid, Dr. Lui suggested: "Perhaps the most tantalizing irony of daylight PDT is the specter of treating a solar-induced neoplasm with sunlight itself."
Dr. Lui is head of the department of dermatology and skin science at the University of British Columbia in Vancouver. He disclosed financial associations with Galderma, LEO Pharma, Janssen, Novartis, Valeant Pharmaceuticals, RepliCel Life Sciences, Lumen Health Technologies, and Verisante Technology.
Several limitations associated with photodynamic therapy (PDT) make cryotherapy the first-line treatment choice for most practicing dermatologists, Dr. Harvey Lui commented in an article that accompanied Dr. Patel’s report.
Dr. Patel’s meta-analysis found a 14% better chance of complete clearance of actinic keratosis lesions, compared with cryotherapy, but the data are not clear enough to claim better cosmesis or patient acceptance, Dr. Lui said (JAMA Dermatol. 2014 Aug. 27 [doi:10.1001/jamadermatol.2014.1869]).
|
|
PDT costs more in time and equipment than cryotherapy. PDT may seem simple, but achieving optimal results can require longer drug incubation times and/or light-dose fractionation. Local pain is a bigger problem with PDT that requires anticipation and management by clinicians, he said. Cryotherapy, on the other hand, requires relatively brief outpatient visits.
The future of PDT for actinic keratosis may lie in further development of a currently off-label treatment – exposure to ambient outdoor light after application of topical aminolevulinic acid, Dr. Lui suggested: "Perhaps the most tantalizing irony of daylight PDT is the specter of treating a solar-induced neoplasm with sunlight itself."
Dr. Lui is head of the department of dermatology and skin science at the University of British Columbia in Vancouver. He disclosed financial associations with Galderma, LEO Pharma, Janssen, Novartis, Valeant Pharmaceuticals, RepliCel Life Sciences, Lumen Health Technologies, and Verisante Technology.
Thin actinic keratoses on the face or scalp were 14% more likely to clear completely in patients treated with photodynamic therapy, compared with cryotherapy, in a meta-analysis of four studies including 641 patients.
Complete clearance 3 months after treatment was significantly more likely in the 2,170 actinic keratoses treated by photodynamic therapy (PDT), compared with 2,174 actinic keratoses treated by cryotherapy, Dr. Gayatri Patel and her associates reported.
The data came from randomized trials with 10 or more participants in which the PDT used topical aminolevulinic acid hydrochloride or methyl aminolevulinate hydrochloride, the most widely available PDT stabilizers in North America and Europe. Methyl aminolevulinate recently was withdrawn from the U.S. market but remains common in Europe, noted Dr. Patel of the University of California, Davis, and her associates.
The study results were published online in JAMA Dermatology (2014 Aug. 27 [doi:10.1001/jamadermatol.2014.1253]).
The results suggested that PDT works better on thinner actinic keratoses. Grade 1 (thin) actinic keratoses on the face or scalp were 86% more likely to clear by 12 weeks after PDT, compared with cryotherapy, the investigators reported.
Only one of the fours studies found higher efficacy rates for cryotherapy, compared with PDT, and more than 60% of lesions in that study were grade 2 (moderately thick, easily felt) or grade 3 (very thick and/or obvious) actinic keratoses. The other three studies in the meta-analysis excluded thicker lesions or favored thinner ones, the researchers noted.
They excluded from the meta-analysis two other studies that compared PDT with cryotherapy for actinic keratoses because of incompatible follow-up times. They reviewed 13 studies in all, including studies involving treatment of actinic keratosis with imiquimod, fluorouracil, or carbon dioxide laser, but could not meta-analyze data on these other treatments because of different outcome measures and follow-up times or lack of a comparator.
Photosensitivity, pain, erythema, and pruritus were common after PDT. Cryotherapy induced pain and pruritus, but at lower rates than did PDT. Hypopigmentation occurred in 33% of patients after cryotherapy and in 9% after PDT in one study.
Satisfaction ratings by patients and unblinded investigators tended to favor PDT over cryotherapy, perhaps because PDT may produce ancillary cosmetic improvements when treating actinic keratosis, Dr. Patel and her associates speculated.
The findings were limited by the poor quality of the studies, which were lacking double-blind design and description of randomization methods, but no sources of bias were evident, and the large number of patients and relatively similar treatment locations were strengths of the analysis, they said.
Dr. Patel reported having no financial disclosures.
On Twitter @sherryboschert
Thin actinic keratoses on the face or scalp were 14% more likely to clear completely in patients treated with photodynamic therapy, compared with cryotherapy, in a meta-analysis of four studies including 641 patients.
Complete clearance 3 months after treatment was significantly more likely in the 2,170 actinic keratoses treated by photodynamic therapy (PDT), compared with 2,174 actinic keratoses treated by cryotherapy, Dr. Gayatri Patel and her associates reported.
The data came from randomized trials with 10 or more participants in which the PDT used topical aminolevulinic acid hydrochloride or methyl aminolevulinate hydrochloride, the most widely available PDT stabilizers in North America and Europe. Methyl aminolevulinate recently was withdrawn from the U.S. market but remains common in Europe, noted Dr. Patel of the University of California, Davis, and her associates.
The study results were published online in JAMA Dermatology (2014 Aug. 27 [doi:10.1001/jamadermatol.2014.1253]).
The results suggested that PDT works better on thinner actinic keratoses. Grade 1 (thin) actinic keratoses on the face or scalp were 86% more likely to clear by 12 weeks after PDT, compared with cryotherapy, the investigators reported.
Only one of the fours studies found higher efficacy rates for cryotherapy, compared with PDT, and more than 60% of lesions in that study were grade 2 (moderately thick, easily felt) or grade 3 (very thick and/or obvious) actinic keratoses. The other three studies in the meta-analysis excluded thicker lesions or favored thinner ones, the researchers noted.
They excluded from the meta-analysis two other studies that compared PDT with cryotherapy for actinic keratoses because of incompatible follow-up times. They reviewed 13 studies in all, including studies involving treatment of actinic keratosis with imiquimod, fluorouracil, or carbon dioxide laser, but could not meta-analyze data on these other treatments because of different outcome measures and follow-up times or lack of a comparator.
Photosensitivity, pain, erythema, and pruritus were common after PDT. Cryotherapy induced pain and pruritus, but at lower rates than did PDT. Hypopigmentation occurred in 33% of patients after cryotherapy and in 9% after PDT in one study.
Satisfaction ratings by patients and unblinded investigators tended to favor PDT over cryotherapy, perhaps because PDT may produce ancillary cosmetic improvements when treating actinic keratosis, Dr. Patel and her associates speculated.
The findings were limited by the poor quality of the studies, which were lacking double-blind design and description of randomization methods, but no sources of bias were evident, and the large number of patients and relatively similar treatment locations were strengths of the analysis, they said.
Dr. Patel reported having no financial disclosures.
On Twitter @sherryboschert
FROM JAMA DERMATOLOGY
Key clinical point: Clearance of thin actinic keratosis lesions on the face or head is more likely with photodynamic therapy vs. cryotherapy, but the impact of either treatment on reducing the incidence of squamous cell carcinomas remains unknown.
Major finding: Clearance was 14% more likely at 3 months after PDT, compared with cryotherapy.
Data source: Meta-analysis of four studies including 641 patients with 2,170 actinic keratosis lesions treated by PDT and 2,174 treated by cryotherapy.
Disclosures: Dr. Patel reported having no financial disclosures.
