Morton et al

Title: Intraindividual, right-left comparison of topical methyl aminolevulinate-photodynamic therapy and cryotherapy in subjects with actinic keratoses: a multicentre, randomised controlled study.

Author: Morton C, Campbell S, Gupta G,  Keohane S et al.

Journal Reference: Brit J. Dermatol. 2006;155(5):1029-36 (by clicking on this link you will be leaving this site - Galderma is not responsible for the content)

Objective: to compare the lesion response and subject preference for topical photodynamic therapy (PDT) using methyl aminolevulinate (MAL; Metvix®) versus cryotherapy in actinic keratoses (AK)

Design: this was a multicentre, open, controlled, randomised trial using an intraindividual right-left comparison design. A total of 119 adult patients (1501 lesions) with mild or moderate (grade 1 and 2) AK with similar severity and distribution of lesions received either PDT with MAL or cryotherapy. Cryotherapy was administered until there was a 1-2mm frozen rim around the lesion. The treatments could be repeated after 12 weeks if necessary and final assessments were made at 24 weeks on lesion reduction from baseline, cosmetic outcome and patient preference.

Key Results:

At week 24 the efficacy of the two groups was comparable (89.1% vs 86.1% lesion reduction from baseline for MAL-PDT and cryotherapy, respectively; p=0.20). After only one treatment at week 12, however the lesion reduction rates were superior for MAL-PDT vs cryotherapy (86.9% vs 76.2%, respectively; p<0.001). Twice as many patients (20.6%) required re-treatment at week 12 with cryotherapy when compared with MAL-PDT (10.2%). Cosmetic outcomes were superior for MAL-PDT at both week 12 (excellent rating in 70.8% for MAL-PDT vs 57.4% for cryotherapy) and week 24 (excellent rating of 77.2% for MAL-PDT vs 49.7% for cryotherapy). In addition when asked to express a preference for re-treatment, 64.8% preferred MAL-PDT compared to 31.5% for cryotherapy.

Conclusion: photodynamic therapy with MAL was as efficacious as cryotherapy using a double-freeze-thaw cycle in treatment of AK of the face and scalp, however less patients required re-treatment after a single MAL-PDT session. Cosmetic outcomes tended to be superior for MAL-PDT and there was a definite preference expressed by patients for MAL-PDT when compared with cryotherapy.