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

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

卷:80

Article

Neugebauer, Romain¹  Su, Katherine A.^2,3  Zhu, Zheng¹  Sokil, Monica¹  Chren, Mary-Margaret⁴  Friedman, Gary D.¹  Asgari, Maryam M.^1,2,3 

[1] Kaiser Permanente Northern Calif, Div Res, Oakland, CA USA

[2] Massachusetts Gen Hosp, Dept Dermatol, 50 Staniford St,Suite 270, Boston, MA 02114 USA

[3] Harvard Med Sch, Dept Populat Med, Harvard Pilgrim Hlth Care Inst, Boston, MA 02115 USA

[4] Vanderbilt Univ, Med Ctr, Dept Dermatol, Nashville, TN USA

关键词: actinic keratosis;    basal cell carcinoma;    comparative effectiveness;    5-fluorouracil;    imiquimod;    keratinocyte carcinoma;    skin cancer;    squamous cell carcinoma;   

DOI  :  10.1016/j.jaad.2018.11.024

来源: Elsevier

【 摘 要 】

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.

【 授权许可】

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