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Photodynamic therapy with BF‐200 ALA for the treatment of actinic keratosis: results of a prospective,randomized, double‐blind,placebo‐controlled phase III study
Authors:R.‐M. Szeimies  P. Radny  M. Sebastian  F. Borrosch  T. Dirschka  G. Krähn‐Senftleben  K. Reich  G. Pabst  D. Voss  M. Foguet  R. Gahlmann  H. Lübbert  U. Reinhold
Affiliation:1. Department of Dermatology, Regensburg University Hospital, Regensburg, Germany;2. Private Practice, Friedrichshafen, Germany;3. Private Practice, Mahlow, Germany;4. Private Practice, Vechta, Germany;5. Private Practice, Wuppertal‐Barmen, Germany;6. Private Practice, Blaubeuren, Germany;7. Dermatologikum Hamburg, Hamburg, Germany;8. FOCUS Clinical Drug Development GmbH, Neuss, Germany;9. Biofrontera Bioscience GmbH, Leverkusen, Germany;10. Medical Centre Bonn, Bonn, Germany
Abstract:Background Photodynamic therapy (PDT) with 5‐aminolaevulinic acid (ALA) provides a therapeutic option for the treatment of actinic keratosis (AK). Different strategies are applied to overcome the chemical instability of ALA in solution and to improve skin penetration. A new stable nanoemulsion‐based ALA formulation, BF‐200 ALA, is currently in clinical development for PDT of AK. Objectives To evaluate the efficacy and safety of PDT of AK with BF‐200 ALA. Methods The study was performed as a randomized, multicentre, double‐blind, placebo‐controlled, interindividual, two‐armed trial with BF‐200 ALA and placebo. A total of 122 patients with four to eight mild to moderate AK lesions on the face and/or the bald scalp were included in eight German study centres. The efficacy of BF‐200 ALA after one and two PDT treatments was evaluated. BF‐200 ALA was used in combination with two different light sources under illumination conditions defined by European competent authorities. Results PDT with BF‐200 ALA was superior to placebo PDT with respect to patient complete clearance rate (per‐protocol group: 64% vs. 11%; P < 0·0001) and lesion complete clearance rate (per‐protocol group: 81% vs. 22%) after the last PDT treatment. Statistically significant differences in the patient and lesion complete clearance rates and adverse effect profiles were observed for the two light sources, Aktilite® CL128 and PhotoDyn® 750, at both time points of assessment. The patient and lesion complete clearance rates after illumination with the Aktilite® CL128 were 96% and 99%, respectively. Conclusions BF‐200 ALA is a very effective new formulation for the treatment of AK with PDT. Marked differences between the efficacies and adverse effects were observed for the different light sources used. Thus, PDT efficacy is dependent both on the drug and on the characteristics of the light source and the illumination conditions used.
Keywords:actinic keratosis  aminolaevulinic acid  multicentre trial  phase III  photodynamic therapy  randomized controlled trial
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