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.

中文翻译：

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一项基于社区的真实世界队列研究，比较了局部用氟尿嘧啶和局部咪喹莫特治疗光化性角化病的有效性

背景

用于现场治疗多种光化性角化病（AK）的最广泛使用的局部用药是5-氟尿嘧啶和咪喹莫特，但在现实世界中尚未评估它们的比较效果。

客观的

我们在加利福尼亚北部的大型综合医疗保健提供系统中比较了5-氟尿嘧啶和咪喹莫特在降低后续AKs风险方面的有效性。

方法

在这项队列研究中，我们确定了在2007年被确诊为AK并随后开具5-氟尿嘧啶或咪喹莫特（N = 5700）处方的成年健康计划成员。我们跟踪受试者进行国际疾病分类法确定的后续AK，并估计累积风险的2年（短期）和5年（长期）差异，同时通过预处理变量控制潜在的混淆。

结果

5-氟尿嘧啶降低了后续AK的短期发生率（累积风险差异-4.54％[95％置信区间，-7.91％至-1.17％]），但没有统计学上的显着证据表明长期降低的风险（累积风险差异-1.43％[95％置信区间，-3.43％至0.05％]）。

局限性

这是一项回顾性研究，仅对所有相关的潜在混淆变量进行了有限的确定。

结论

我们发现5-氟尿嘧啶在短期而非长期预防后续AK方面似乎比咪喹莫特显着更有效。