Article Published in JAMA Dermatology Shows Long-term Effectiveness of Ingenol Mebutate in Treating Actinic Keratosis

PR52495

BALLERUP, Denmark, Mar. 21, 2013 /PRN=KYODO JBN/ --

    - Two-three day treatment provides clinically relevant, sustained clearance

of AK after 12 months

    An analysis of long-term clearance rates of actinic keratosis (AK) lesions

after treatment with ingenol mebutate (Picato(R)) gel is today published in the

Journal of the American Medical Association (JAMA) Dermatology,[1] formerly

known as the Archives of Dermatology.

     (Photo: http://photos.prnewswire.com/prnh/20130221/595427 )

    Previously, the pooled results of the four phase III trials of ingenol

mebutate published in the New England Journal of Medicine (NEJM) showed that

ingenol mebutate gel effectively clears AK lesions after a two or three day

topical treatment of an area of skin (also known as a field).[2]  

    The current data in JAMA Dermatology show that patients who achieved

complete clearance after initial treatment with ingenol mebutate gel, also

experience sustained clearance of AK lesions one year later.[1]

    The primary outcome of the study showed that patients showing sustained

complete clearance at 12 months, was 46% on the face and scalp and 44% on the

trunk or extremities. The secondary outcome showed that patients in the overall

population experienced approximately 87% reduction in the original number of

actinic keratoses in the treated area of skin.[1]

    The authors of the article 'Long-Term Follow-up of Ingenol Mebutate Gel for

the Treatment of Actinic Keratosis' concluded:  

    "Ingenol mebutate gel applied as field therapy for only two or three

consecutive daily doses was effective when treating head or body actinic

keratoses, producing clinically relevant sustained clearance and long-term

reduction in lesions."[1]

    Author Dr Stephen Shumack, a Consultant Dermatologist from Sydney's Royal

North Shore Hospital, Australia, commented:

    "These long-term data are encouraging for patients with actinic keratosis.

It has now been demonstrated that once daily, two or three day treatment with

ingenol mebutate gel leads to a reduction in the number of actinic keratoses

present after 12 months, compared to the number seen at baseline. These results

are comparable to those seen with other topical therapies with longer treatment

durations.[1]These data show long-term effectiveness combined with short

duration of treatment, offering a significant benefit to patients living with

actinic keratosis."

    Dr Kim Kjoller, Senior Vice President of Global Development at LEO, said:

    "These data provide clear evidence that ingenol mebutate gel is effective

in sustaining long-term clearance of actinic keratoses. The short duration of

treatment required for ingenol mebutate is an important step in providing

convenient and effective solutions to treat this widespread condition."

    Actinic keratoses are rough skin lesions caused by cumulative exposure to

the sun, which can potentially lead to non-melanoma skin cancer (NMSC) if not

treated early and effectively.[3] The majority of lesions are caused by

long-term sun exposure in fair-skinned people. The number of patients with

actinic keratosis is rapidly growing, especially in Europe, the US and

Australia.[4]  

    Ingenol mebutate gel is available in two different concentrations. For

treatment of the face and scalp, ingenol mebutate gel is applied at a

concentration of 150 mcg/g over a 25 cm[2] area once daily for three

consecutive days. For treatment of the body, ingenol mebutate gel is applied

over a 25 cm[2] area once daily for two consecutive days at a concentration of

500 mcg/g.

    Ingenol mebutate gel was approved by the US Food and Drug Administration

(FDA) in January 2012; by the Agencia Nacional de Vigilancia Sanitaria (ANVISA)

in Brazil in July 2012; and by the Therapeutic Goods Administration (TGA) in

Australia, the European Commission (EC) in Europe in November 2012 and by

Health Canada in January 2013.

    About Picato(R) gel

    Picato(R) gel is a topical, field-directed therapy which is

self-administered by the patient to the affected areas of the skin once a day

for two or three consecutive days, depending on the treatment area.

    Picato(R) gel has two strengths and two application regimens to follow,

dependent upon the location of the actinic keratoses. Picato(R) gel is applied

over a 25cm[2] treatment area for two consecutive days when treating actinic

keratoses on the trunk and extremities (500 mcg/g) and over three consecutive

days for the face and scalp (150mcg/g).

    Picato(R) gel has been shown in a large clinical trial programme to

effectively clear actinic keratosis lesions on the face and scalp, as well as

on the trunk and extremities.[2]

    The mechanism of action (MoA) for Picato(R) gel is not fully understood. In

vivo and in vitro data suggest a dual MoA, including direct lesional cell death

and infiltration of immunocompetent cells.[5],[6]

    Non-invasive examination of skin treated with Picato(R) gel showed an

almost complete resolution of induced skin changes measured at two months post

treatment, and patients treated with Picato(R) gel showed a higher treatment

satisfaction than placebo-treated patients in clinical trials.[2]

    Important product information

    Contact with the eyes should be avoided. Eye disorders such as eye pain,

eyelid oedema and periorbital oedema should be expected to occur after

accidental eye exposure of Picato(R) gel.

    Picato(R) gel must not be ingested.

    Administration of Picato(R) gel is not recommended until the skin is healed

from treatment with any previous medicinal product or surgical treatment and

should not be applied to open wounds or damaged skin where the skin barrier is

compromised.

    Picato(R) gel should not be used near the eyes, on the inside of the

nostrils, on the inside of the ears or on the lips.

    Local skin responses such as erythema, flaking/scaling, and crusting should

be expected to occur after cutaneous application of Picato(R) gel.

    Due to the nature of the disease, excessive exposure to sunlight (including

sunlamps and tanning beds) should be avoided or minimised.

    Lesions clinically atypical for actinic keratosis or suspicious for

malignancy should be biopsied to determine appropriate treatment.

    There are no data from the use of ingenol mebutate in pregnant women. Risks

to humans receiving cutaneous treatment with ingenol mebutate are considered

unlikely as Picato(R) gel is not absorbed systemically. As a precautionary

measure, it is preferable to avoid the use of Picato(R) gel during pregnancy.

    Actinic keratosis is not a condition generally seen within the pediatric

population. The safety and efficacy of Picato(R) gel for actinic keratosis in

patients less than 18 years of age have not been established.

    Please see full prescribing information available at

http://www.leo-pharma.com.  

    About actinic keratosis (AK)

    Actinic keratoses are skin lesions, which are often red, scaly and may

initially be mistaken for a rash or other skin irritation. The majority of

lesions are caused by sun exposure in fair-skinned people.  

    The number of patients with actinic keratosis is rapidly growing,

especially in Europe, the US and Australia.[4]

    Actinic keratoses are more common in males, and individuals with a fair

skin type. Additional risk factors include advanced age and immunodeficiency.

Immunocompromised patients have a 65 to 250 fold higher risk for actinic

keratoses and invasive squamous cell carcinoma, which is a type of NMSC.[7]  

    Actinic keratosis is a precursor to non-melanoma skin cancer which is the

second most common type of skin cancer. [8],[9]

    After receiving a diagnosis of actinic keratosis, the risk of developing

squamous cell carcinoma over a ten year period is approximately ten per cent

for a patient having an average of 7.7 actinic keratosis lesions,[8],[10],[11]

and it is impossible to predict which lesions will develop into skin

cancer.[12]  

    A study has shown that around between 40-80 per cent of squamous cell

carcinoma cases may begin as actinic keratoses,[8],[13],[14] and patients with

the condition are six times more likely to develop any type of skin cancer than

people without it.[15]  

    About LEO Pharma

    Founded in 1908, LEO Pharma is an independent, research-based

pharmaceutical company.

    LEO Pharma develops, manufactures and markets pharmaceutical drugs to

dermatologic and thrombotic patients in more than 100 countries globally.

    The company has its own sales forces in 61 countries and employs around

5,000 people worldwide.

    LEO Pharma is headquartered in Denmark and is wholly owned by the LEO

Foundation.

    For more information about LEO Pharma, visit http://www.leo-pharma.com.

    References

    Lebwohl M, Shumack, S et al., Long-Term Follow-up of Ingenol Mebutate Gel

for the Treatment of Actinic Keratosis  JAMA Dermatology; Article in press

    Lebwohl M, Swanson N, Anderson LL, Melgaard A, Xu Z, Berman B. Ingenol

mebutate gel for actinic keratosis. N Engl J Med. Mar 15 2012;366(11):1010-1019

    Cohen JL. Actinic keratosis treatment as a key component of preventive

strategies for nonmelanoma skin cancer. J Clin Aesthet Dermatol. Jun

2010;3(6):39-44.

    Ulrich M, Drecoll U, Stockfleth E. Emerging drugs for actinic keratosis.

Expert Opin Emerg Drugs. Dec 2010;15(4):545-555.

    Cozzi SJ, Ogbourne SM, James C, et al. Ingenol mebutate field-directed

treatment of UVB-damaged skin reduces lesion formation and removes mutant p53

patches. J Invest Dermatol. Apr 2012;132(4):1263-1271.

    Ogbourne SM, Suhrbier A, Jones B, et al. Antitumor activity of 3-ingenyl

angelate: plasma membrane and mitochondrial disruption and necrotic cell death.

Cancer Res. Apr 15 2004;64(8):2833-2839.

     Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ

transplantation. N Engl J Med. Apr 24 2003;348(17):1681-1691.

     Mittelbronn MA, Mullins DL, Ramos-Caro FA, Flowers FP. Frequency of

pre-existing actinic keratosis in cutaneous squamous cell carcinoma. Int J

Dermatol. Sep 1998;37(9):677-681.

    Berman B, Amini S, Valins W, Block S. Pharmacotherapy of actinic keratosis.

Expert Opin Pharmacother. Dec 2009;10(18):3015-3031.

    Dodson JM, DeSpain J, Hewett JE, Clark DP. Malignant potential of actinic

keratoses and the controversy over treatment. A patient-oriented perspective.

Arch Dermatol. Jul 1991;127(7):1029-1031.

    Salasche SJ. Epidemiology of actinic keratoses and squamous cell carcinoma.

J Am Acad Dermatol. Jan 2000;42(1 Pt 2):4-7.

    Stockfleth E. Topical management of actinic keratosis and field

cancerisation. G Ital Dermatol Venereol. Aug 2009;144(4):459-462.

    Feldman SR, Fleischer AB, Jr. Progression of actinic keratosis to squamous

cell carcinoma revisited: clinical and treatment implications. Cutis

2011;87(4):201-7.

    Dinehart, Nelson-Adesokan, Cockerell, Russell, Brown. Metastatic cutaneous

squamous cell carcinoma derived from actinic keratosis. Cancer 1997;

79(5):920-3.

    Chen GJ, Feldman SR, Williford PM, et al. Clinical diagnosis of actinic

keratosis identifies an elderly population at high risk of developing skin

cancer. Dermatol Surg. Jan 2005;31(1):43-47.

     SOURCE: LEO Pharma A/S