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Original Investigation
December 2014

Efficacy of Photodynamic Therapy vs Other Interventions in Randomized Clinical Trials for the Treatment of Actinic Keratoses: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Department of Internal Medicine, University of California Davis Medical Center, Sacramento
  • 2Department of Dermatology, University of Colorado, Aurora
  • 3Department of Dermatology, University of California Davis Medical Center, Sacramento
JAMA Dermatol. 2014;150(12):1281-1288. doi:10.1001/jamadermatol.2014.1253

Importance  Photodynamic therapy (PDT) is used extensively to treat actinic keratoses (AKs). An analysis of the effectiveness of PDT compared with other treatments may help physicians decide what role it should play in their own clinical practices.

Objective  To determine the effectiveness of PDT for the treatment of AKs relative to other methods.

Data Sources  MEDLINE, EMBASE, Web of Knowledge, and Cochrane Central Register. No restrictions on years were placed, and all searches extended to the year of each database inception. Our search was conducted on March 20, 2013, and included the search terms solar keratosis, actinic keratosis, photodynamic therapy, and photochemotherapy. No restrictions were used for the search string.

Study Selection  Only randomized PDT trials that used aminolevulinic acid hydrochloride or methyl aminolevulinate hydrochloride as stabilizers with 10 or more participants were considered. Two of the authors undertook the search independently.

Data Extraction and Synthesis  Data were extracted independently by the 2 authors. We assessed data quality using the Jadad scoring system and used a random-effects model for pooled data analysis.

Main Outcomes and Measures  Primary outcome measures specified a priori were lesion response, cosmetic results, and patient satisfaction after the intervention.

Results  Our search identified 875 journal articles and meeting abstracts. We excluded 862 owing to lack of adherence to our inclusion criteria or lack of author response to our queries for further information. We assessed 13 studies for inclusion in our final synthesis, of which 4 were eligible for final meta-analysis. The only comparator for which meta-analysis was performed was cryotherapy. The meta-analysis consisted of 641 participants, with a total of 2174 AKs treated with cryotherapy and 2170 AKs treated with PDT. Compared with cryotherapy, the pooled relative risk for the meta-analysis for complete response (lesion clearance) was 1.14 (95% CI, 1.11-1.18) at 3 months after treatment. Visual inspection of a funnel plot revealed no publication bias, which was confirmed by the Begg test (P = .80).

Conclusions and Relevance  Photodynamic therapy has a 14% better chance of complete lesion clearance at 3 months after treatment than cryotherapy for thin AKs on the face and scalp.