Efficacy and safety of ingenol mebutate gel in field treatment of actinic keratosis on full face, balding scalp, or approximately 250 cm on the chest: A phase 3 randomized controlled trial.

Background: Ingenol mebutate (IngMeb) 0.015% or 0.05% is approved for actinic keratosis (AK) areas of 25 cm or less; some patients require treatment of larger fields.

Objective: To determine efficacy and safety of IngMeb 0.027% in areas of AK of up to 250 cm during an 8-week initial assessment period and extended 12-month follow-up.

Methods: This phase 3, randomized, double-blind, vehicle-controlled trial (NCT02361216) enrolled adult patients with 5 to 20 AK lesions on the face/scalp (25-250 cm) or chest (approximately 250 cm). Patients received once-daily IngMeb or vehicle for 3 consecutive days on the full face, full balding scalp, or approximately 250 cm on the chest. The primary endpoint was complete AK clearance (AKCLEAR 100; week 8). Additional endpoints included partial AK clearance (AKCLEAR 75), recurrence, patient satisfaction, cosmetic outcome, and safety.

Results: IngMeb was superior to vehicle for complete AK clearance (21.4% vs 3.4%, P < .001) and AK clearance of 75% or greater (59.4% vs 8.9%, P < .001) at week 8. Probability of sustained clearance during the 12-month follow-up was 22.9% for patients treated with IngMeb. Increased treatment satisfaction and cosmetic outcomes were observed with IngMeb versus vehicle. No unexpected safety signals were identified.

Limitations: Localized skin responses hindered maintenance of double-blinding.

Conclusions: IngMeb 0.027% was superior to vehicle for treatment of AK areas of up to 250 cm. The safety profile of IngMeb was as expected.