Considerations in the Management of Actinic Keratoses: The Importance of Adherence and Persistence to Therapy

Abstract

Background: Actinic keratosis (AK) is a pre-malignant lesion with a poorly defined risk of progression to invasive squamous cell carcinoma (SCC). AKs are also associated with increased future risk of invasive SCC. However, there are many barriers to therapy adherence that may affect long-term treatment efficacy. Objective: To review the current literature reporting known known factors of AK treatment non-adherence intrinsic to patient behavior and treatment regimens and re-examine how dermatologists can navigate these challenges. Methods: A Medline literature search was performed to identify existing evidence regarding barriers to adherence with AK treatment regimens intrinsic to patient behavior, patient counseling, and treatment regimens pertinent for review. Results & Discussion: Factors intrinsic to prescribed patient-applied therapy that can exacerbate non-adherence include: 1) length of treatment duration, 2) frequency of application, 3) complexity of treatment regimen, 4) duration and 5) severity of local skin reactions (LSR) and adverse reactions. Novel mechanisms of action that induce cellular apoptosis (as opposed to necrosis) via inhibition of tubulin polymerization and cell cycle arrest, may promote treatment regimen adherence and long-term outcomes. Dermatologists should also be conscious of how they counsel patients as insufficient counseling may also lead to poor adherence. Conclusion: Dermatologists must understand the value of shorter course therapies and their positive impact on adherence and be well-versed in the mechanisms, efficacy and adverse events associated with treatment options. By doing so, dermatologists may best counsel and educate patients and devise regimens that address individualized patient concerns.

Efficacy and safety of tirbanibulin 1% ointment in actinic keratoses: Data from two phase‐III trials and the real‐life clinical practice presented at the European Academy of Dermatology and Venereology Congress 2022

“…All treatments demonstrate good efficacy, though not all are well tolerated. In particular, 5‐FU and PDT are known to be less tolerated owing to substantial inflammatory responses through their mode of action (necrosis) 23 . Additionally, conventional PDT is considered quite painful and results in strong irritation of the skin.…”

“…In particular, 5-FU and PDT are known to be less tolerated owing to substantial inflammatory responses through their mode of action (necrosis). 23 Additionally, conventional PDT is considered quite painful and results in strong irritation of the skin. Daylight PDT, on the other hand, is less prone to irritation and quite well tolerated.…”

“…The controlled manner in which tirbanibulin induces apoptosis allows for limited inflammation/LSRs to occur. 23 In addition to being efficacious and safe, AK treatments should meet patients' needs and preferences. To this effect, better tolerability and ease of use (e.g.…”

Advances and Considerations in the Management of Actinic Keratosis: An Expert Consensus Panel Report

“…50 One of the advantages of tirbanibulin is that its shorter therapy duration and reduced length and degree of LSRs has the potential to enhance adherence. 51…”

Clinician- and Patient-Reported Outcomes with Tirbanibulin 1% Treatment for Actinic Keratosis in Routine Clinical Practice Across the U.S. (PROAK Study)

“…Although clinical studies of topical treatments result in high therapeutic efficacy, in realworld, treatment length, regimen complexity, LSR presence and recurrence rates may impact treatment adherence, leading to poor outcomes. 2,6,14,18 In addition, AK lesions occur primarily on visible, sun-exposed areas, and negatively affect patients' quality of life (QoL), affecting emotional and social functioning. 19,20 Therefore, it is critical to understand patients' experiences and preferences regarding AK treatments, as their perspective may optimize adherence and clinical outcomes.…”