Fluorouracil better than imiquimod in short-term prevention of subsequent actinic keratoses
A recent study has shown that 5-fluorouracil is significantly more effective than imiquimod in the short-term prevention of subsequent actinic keratoses (AKs).
Treatment with 5-fluorouracil successfully decreased the incidence of subsequent AKs (cumulative risk difference, –4.54 percent; 95 percent CI, –7.91 to –1.17 percent) in the short term. However, no statistically significant evidence was found with regard to a long-term reduced risk (cumulative risk difference, –1.43 percent; –3.43 to 0.05 percent) compared with that with imiquimod.
This community-based cohort study identified adult health plan members who had an AK diagnosed in 2007 and who subsequently filled a prescription for 5-fluorouracil or imiquimod (n=5,700). The investigators followed participants for subsequent AKs identified by the International Classification of Diseases codes and estimated the short- (2 years) and long-term (5 years) differences in cumulative risk while controlling for potential confounding by pretreatment variables.
“This is a retrospective study with limited ascertainment of all relevant potential confounding variables,” the investigators said.
In an earlier study, Tanghetti and Werschler found that 5-fluorouracil cream twice daily for 2–4 weeks was more effective than imiquimod cream twice weekly for 16 weeks in exposing what were presumed to be subclinical AKs, reducing the final AK count, achieving complete clearance and achieving clearance rapidly. [J Drugs Dermatol 2007;6:144-147]
“Tolerability was similar except for erythema, which was initially significantly higher with 5-fluorouracil than imiquimod but resolved rapidly and was significantly lower than imiquimod by week 16. Five-percent 5-fluorouracil remains the gold standard field therapy for AKs,” Tanghetti and Werschler said.