The combination of photodynamic therapy and another topical treatment may be superior to monotherapy for treatment of actinic keratoses, according to a meta-analysis published in the Journal of The European Academy of Dermatology and Venereology.

Researchers completed a systematic literature review of Medline, Embase, and CENTRAL databases to assess the efficacy and tolerability of adding photodynamic therapy to topical interventions in patients with actinic keratoses. Randomized control trials with patients who were clinically or histopathologically diagnosed with actinic keratoses, used an intervention of field-direct photodynamic therapy treatment or daylight photodynamic therapy or a combination of both, and contained a comparison group were included in this meta-analysis. Outcomes were clearance rates, pain from treatment, and local skin reactions.

Of the 10 studies included in the meta-analysis, 4 used photodynamic therapy and imiquimod cream, 3 used photodynamic therapy and 5-fluorouracil cream, 1 used photodynamic therapy and ingenol mebutate 0.015% gel, 1 used photodynamic therapy and tazarotene 0.1% gel, and 1 used photodynamic therapy and calcipotriol ointment. When compared with monotherapy, photodynamic therapy in combination with a topical treatment had significantly higher complete clearance rates (risk ratio [RR] 1.63; 95% CI, 1.15-2.33; P =.007) and partial clearance rates (RR 1.19; 95% CI, 0.84-1.67; P =.33). Reports of pain from treatment were mixed, with one study reporting no patients experiencing pain from treatment and one study reporting that combination therapy was more painful than monotherapy. Local skin reactions were reported in only one study with very low quality of evidence.

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Limitations of this study include a high clinical heterogeneity of interventions, short-term efficacy follow-ups, the outcome quality of evidence was rated as low or very low, and there was a high estimated risk for bias.

The researchers concluded, “the combination of [photodynamic therapy] with another topical modality may offer efficacy benefits compared to one field-directed treatment alone.”

Disclosures: Several authors report multiple associations with pharmaceutical companies. Please refer to original reference for a complete list of authors’ disclosures.

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Reference

Heppt MV, Steeb T, Leiter U, Berking C. Efficacy of photodynamic therapy combined with topical interventions for the treatment of actinic keratosis: a meta-analysis [published online February 1, 2019]. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.15459