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Reynolds KA, Schlessinger DI, Vasic J, Iyengar S, Qaseem Y, Behshad R, DeHoratius DM, Denes P, Drucker AM, Dzubow LM, Etzkorn JR, Harwood C, Kim JYS, Lee EH, Lissner GS, Marghoob AA, Matin RN, Mattox A, Mittal BB, Thomas JR, Zhou XA, Zloty D, Schmitt J, Kirkham J, Poon E, Sobanko JF, Cartee TV, Maher IA, Alam M. Core Outcome Set for Actinic Keratosis Clinical Trials. JAMA Dermatol 2020; 156:326-333. [PMID: 31939999 DOI: 10.1001/jamadermatol.2019.4212] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Although various treatments have been found in clinical trials to be effective in treating actinic keratosis (AK), researchers often report different outcomes. Heterogeneous outcome reporting precludes the comparison of results across studies and impedes the synthesis of treatment effectiveness in systematic reviews. Objective To establish an international core outcome set for all clinical studies on AK treatment using systematic literature review and a Delphi consensus process. Evidence Review Survey study with a formal consensus process. The keywords actinic keratosis and treatment were searched in PubMed, Embase, CINAHL, and the Cochrane Library to identify English-language studies investigating AK treatments published between January 1, 1980, and July 13, 2015. Physician and patient stakeholders were nominated to participate in Delphi surveys by the Measurement of Priority Outcome Variables in Dermatologic Surgery Steering Committee members. All participants from the first round were invited to participate in the second round. Outcomes reported in randomized controlled clinical trials on AK treatment were rated via web-based e-Delphi consensus surveys. Stakeholders were asked to assess the relative importance of each outcome in 2 Delphi survey rounds. Outcomes were provisionally included, pending the final consensus conference, if at least 70% of patient or physician stakeholders rated the outcome as critically important in 1 or both Delphi rounds and the outcome received a mean score of 7.5 from either stakeholder group. Data analysis was performed from November 5, 2018, to February 27, 2019. Findings A total of 516 outcomes were identified by reviewing the literature and surveying key stakeholder groups. After deduplication and combination of similar outcomes, 137 of the 516 outcomes were included in the Delphi surveys. Twenty-one physicians and 12 patients participated in round 1 of the eDelphi survey, with 17 physicians (81%) retained and 12 patients (100%) retained in round 2. Of the 137 candidate outcomes, 9 met a priori Delphi consensus criteria, and 6 were included in the final outcomes set after a consensus meeting: complete clearance of AKs, percentage of AKs cleared, severity of adverse events, patient perspective on effectiveness, patient-reported future treatment preference, and recurrence rate. It was recommended that treatment response be assessed at 2 to 4 months and recurrence at 6 to 12 months, with the AK rate of progression to cutaneous squamous cell carcinoma reported whenever long-term follow-up was possible. Conclusions and Relevance Consensus was reached regarding a core outcome set for AK trials. Further research may help determine the specific outcome measures used to assess each of these outcomes.
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Affiliation(s)
- Kelly A Reynolds
- University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Daniel I Schlessinger
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jelena Vasic
- Division of Dermatology, College of Medicine Tucson, University of Arizona, Tucson, Arizona
| | - Sanjana Iyengar
- Department of Dermatology, West Virginia University, Morgantown
| | - Yaqoob Qaseem
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ramona Behshad
- Department of Dermatology, St Louis University, St Louis, Missouri
| | - Danielle M DeHoratius
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Pablo Denes
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Jeremy R Etzkorn
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Catherine Harwood
- Department of Dermatology, Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom.,Blizard Institute, Barts and the London School of Medicine and Dentistry, Centre for Cutaneous Research and Cell Biology, Queen Mary University of London, London, United Kingdom
| | - John Y S Kim
- Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Erica H Lee
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Gary S Lissner
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ashfaq A Marghoob
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Rubeta N Matin
- Department of Dermatology, Churchill Hospital, Oxford, United Kingdom
| | - Adam Mattox
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Bharat B Mittal
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - J Regan Thomas
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Xiaolong Alan Zhou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David Zloty
- Department of Dermatology & Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jamie Kirkham
- Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joseph F Sobanko
- Department of Dermatology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia.,Division of Dermatologic Surgery, Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Todd V Cartee
- Department of Dermatology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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