Ingenol Mebutate or Diclofenac Sodium to Treat Actinic Keratosis? Is One Better Than the Other?

Ingenol mebutate (IngMeb) and diclofenac sodium (DS) are both approved for treating actinic keratosis (AK) on the face and scalp. A recent study compared them head-to-head for efficacy and safety.

The authors hypothesized that due to factors such as superior clinical outcomes, favorable tolerability, and shorter treatment duration, IngMeb may be preferred by patients and show greater treatment adherence than treatment with DS. The study was a phase IV, multicenter, randomized, open-label, active-controlled, parallel-group trial of the two medications. The primary trial end point was complete clearance of AK lesions at the end of the first treatment course. Over 500 patients were randomized into two groups, but were not blinded to which medication they were receiving.

The results show that the proportion of patients achieving full clearance of AK at the end of the first treatment course was significantly higher in the IngMeb group compared with the DS group. However, patients did not report significantly different experiences with respect to side-effects and convenience. In both groups adverse effects were limited and mild to moderate in severity. IngMeb was superior to DS for the end point of clearing AK at first treatment and that was true at a second evaluation point as well.

The authors state while both are effective, IngMeb may be a more convenient and effective treatment for AK than DS. In addition, the short treatment course and tolerability of the medication might contribute to high adherence and treatment satisfaction.