Latest research on Euphorbia peplus (Petty spurge, Radium weed or Cancer weed/chick weed) for treating actinic keratoses

This is the latest research from the company that bought Peplin which was developing  this plant extract to treat superficial skin cancers. I know many of my patients were using it.

Four Phase 3 Efficacy and Safety Studies of Ingenol Mebutate, an Investigational Treatment for Actinic Keratosis, Presented at World Congress of Dermatology

Ingenol mebutate is an investigational two-to-three day topical treatment for precancerous skin disease
Copenhagen, Denmark – June 6 2011 – Clinical data from four Phase 3 studies of ingenol mebutate gel, an investigational treatment for actinic keratosis, were presented publicly for the first time at the 22nd World Congress of Dermatology in Seoul.  Two of the studies evaluated the efficacy and safety of ingenol mebutate 0.05% applied once daily for two consecutive days to actinic keratoses (multiple lesions) on the body.  The other two studies evaluated the efficacy and safety of ingenol mebutate 0.015% applied once daily for three consecutive days to actinic keratoses on the face and scalp.  The primary endpoint for all four studies was complete clearance rate of actinic keratoses at the day 57 visit.

Actinic keratosis, caused by long-term UV exposure, is a precancerous skin condition, which can lead to squamous cell carcinoma, a non-melanoma form of skin cancer. “Since there is no way to predict which actinic keratoses will advance to skin cancer, early detection and treatment of lesions is critical,” said Mark Lebwohl, M.D., Professor and Chair, Department of Dermatology, Mount Sinai Medical Center in New York.

Face and Scalp Data 
Two of the studies compared ingenol mebutate 0.015% to a placebo (vehicle) applied once daily for three consecutive days to actinic keratoses on the face or scalp.  In the first study, after 57 days (about 8 weeks), complete clearance of actinic keratosis lesions occurred in 47% (67/142) of patients using ingenol mebutate and 5% (7/136) of patients using placebo (P<0.001). The median reduction in total number of lesions from baseline was 87%.1 The second study found complete clearance in 37% (50/135) of patients in the ingenol mebutate group and 2% (3/134) of patients in the vehicle group (P<0.001).2

The most frequently reported local skin responses in the face and scalp studies were erythema (redness), flaking/scaling, and crusting, which peaked on day 4 and returned to below baseline by day 29; 1.  The most common treatment related adverse events were mild or moderate application-site reactions of pain 19% (25/132) and pruritus 11% (14/132); 2% of patients (3) experienced adverse events classified as severe. Treatment adherence was high;  99% and  96% of patients in the active treatment group completed therapy in the respective studies1, 2.

Body Data 
The other two studies compared ingenol mebutate 0.05% to a placebo gel (vehicle) applied once daily for two consecutive days to actinic keratoses on the body (arm, chest, back of the hand, leg, back or shoulder).  In the first study, after 57 days, complete clearance of actinic keratosis lesions occurred in 28% (35/126) of patients using ingenol mebutate and 5% (6/129) of patients using  placebo (P<0.0001).3 The second study found complete clearance of actinic keratosis lesions in 42% (42/100) of patients in the ingenol mebutate group and 5% (5/103) of patients in the vehicle group (P<0.001).4

The most frequently reported local skin responses in the body studies were erythema (redness) and flaking/scaling, which peaked between days 3 and 8  returning to  baseline at day 573,4. Adverse events were generally mild to moderate  resolving by day 573. The most common treatment related adverse events were application-site irritation and itching3. All local skin responses and treatment-related application-site adverse events resolved without sequelae4.

About Ingenol Mebutate
Ingenol mebutate is a topical gel derived from the Euphorbia peplus plant, and is being studied for its effect on actinic keratosis.  Data from the four studies were submitted to the United States Food and Drug Administration (FDA) as part of the New Drug Application (NDA) by LEO Pharma.

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