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外用钙泊三醇加 5-氟尿嘧啶治疗光化性角化病:系统评价。

Use of Topical Calcipotriol Plus 5-Fluorouracil in the Treatment of Actinic Keratosis: A Systematic Review.

出版信息

J Drugs Dermatol. 2022 Jan 1;21(1):60-65. doi: 10.36849/JDD.2022.6632.

Abstract

BACKGROUND

Actinic Keratosis (AK) is a premalignant lesion that can progress to cutaneous squamous cell carcinoma (cSCC). Topical 5-Fluorouracil (5-FU) and imiquimod have been used for field-directed therapy for AK; however, their use is limited by intolerable skin reactions and long treatment durations.

OBJECTIVE

To assess current data on the efficacy, tolerability, and long-term effectiveness of topical calcipotriol plus 5-FU combination for the field-directed therapy of AK. The systematic review will include a critical evaluation of the available evidence.

METHODS

A systematic review of the literature was performed in August 2021 using the EMBASE and MEDLINE databases. Studies that assess the use of calcipotriol and 5-FU to treat actinic keratosis (AK) and cSCC prevention were included.

RESULTS

In total, four studies met the inclusion criteria. Our final analysis included three articles. One clinical trial evaluated the efficacy of calcipotriol plus 5-FU in treating AK. Another clinical trial evaluated the long-term effect of calcipotriol plus 5-FU in prevention of cSCC. A retrospective study evaluated the use of calcipotriol plus 5-FU with cryotherapy.

LIMITATIONS

A limitation of this systematic review is the limited number of clinical trials that examine the combination of 5-FU plus calcipotriol in treating AK. The active control arm (Petroleum jelly plus 5-FU combination) is not equivalent to topical 5-FU monotherapy; hence, no superiority claim can be made vs topical 5-FU in terms of efficacy.

CONCLUSION

Calcipotriol plus 5-FU reduced greater number of AKs in the treated area (25 cm2) when compared to 5-FU plus petroleum jelly, but only 27% of participants had complete clearance on the face at week-8. Calcipotriol plus 5-FU lowered the risk of cSCC on the face and scalp area over a 3-year period. Adequate and well-controlled studies are needed to compare the efficacy of calcipotriol plus 5-FU to 5-FU monotherapy, and other FDA-approved topical drugs such as imiquimod cream and tirbanibulin ointment. J Drugs Dermatol. 2022;21(1):60-65. doi:10.36849/JDD.6632.

摘要

背景

光化性角化病(AK)是一种癌前病变,可进展为皮肤鳞状细胞癌(cSCC)。外用 5-氟尿嘧啶(5-FU)和咪喹莫特已被用于 AK 的区域定向治疗;然而,由于皮肤反应不可耐受和治疗时间长,其应用受到限制。

目的

评估外用钙泊三醇加 5-FU 联合治疗 AK 的区域定向治疗的疗效、耐受性和长期有效性的当前数据。系统评价将包括对现有证据的批判性评估。

方法

2021 年 8 月,使用 EMBASE 和 MEDLINE 数据库进行了系统文献检索。纳入评估钙泊三醇和 5-FU 治疗光化性角化病(AK)和预防 cSCC 用途的研究。

结果

共有 4 项研究符合纳入标准。我们的最终分析包括 3 篇文章。一项临床试验评估了钙泊三醇加 5-FU 治疗 AK 的疗效。另一项临床试验评估了钙泊三醇加 5-FU 预防 cSCC 的长期效果。一项回顾性研究评估了钙泊三醇加 5-FU 联合冷冻疗法的应用。

局限性

本系统评价的一个局限性是检查 5-FU 加钙泊三醇联合治疗 AK 的临床试验数量有限。活性对照组(凡士林加 5-FU 联合)与外用 5-FU 单一疗法不等效;因此,在疗效方面,不能与外用 5-FU 相比具有优越性。

结论

与 5-FU 加凡士林相比,钙泊三醇加 5-FU 在治疗面积(25cm2)中减少了更多的 AK,但只有 27%的参与者在第 8 周时面部完全清除。钙泊三醇加 5-FU 在 3 年内降低了面部和头皮区域发生 cSCC 的风险。需要进行充分和良好控制的研究,以比较钙泊三醇加 5-FU 与 5-FU 单一疗法以及其他 FDA 批准的外用药物(如咪喹莫特乳膏和替拉那滨软膏)的疗效。J 皮肤病学杂志。2022;21(1):60-65。doi:10.36849/JDD.6632.

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