Dirschka, TEkanayake-Bohlig, SDominicus, RAschoff, RHerrera-Ceballos, EBotella-Estrada, RHunfeld, AKremser, MSchmitz, BLübbert, HPuig, S2023-01-252023-01-252018-08-14http://hdl.handle.net/10668/12724The most effective treatment modality for actinic keratosis (AK) is photodynamic therapy (PDT). Major obstacles of PDT are the need of a special illumination device and pain accompanying the illumination. These issues may be overcome by replacing an artificial high-power light source with natural daylight for more extended illumination at lower light doses. To determine whether BF-200 ALA (a nanoemulsion gel containing 7.8% 5-aminolaevulinic acid) is non-inferior to MAL (a cream containing 16% methyl-aminolaevulinate) in the treatment of mild-to-moderate AK with daylight PDT (dPDT). Non-inferiority of the primary efficacy variable (total lesion clearance rate per patient's side 12 weeks after PDT) is established if the mean response for BF-200 ALA is no worse than for MAL, within a statistical margin of Δ = -12.5%. The study was performed as an intraindividual comparison with 52 patients in seven centres in Germany and Spain. Each patient received one dPDT. Results include clinical endpoints as well as 1-year follow-up results. Twelve weeks after a single dPDT, 79.8% of the AK lesions treated with BF-200 ALA gel and 76.5% of the lesions treated with MAL cream were completely cleared. The median of differences was 0.0 with a one-sided 97.5% CI of 0.0, establishing non-inferiority (P Daylight PDT of AK with BF-200 ALA is well-tolerated and non-inferior to MAL/dPDT. The study demonstrates a trend towards higher efficacies after 3 months and significantly lower recurrence rates after 1 year follow-up.enAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/Administration, CutaneousAgedAminolevulinic AcidFemaleGelsGermanyHumansKeratosis, ActinicMalePhotochemotherapyPhotosensitizing AgentsPrognosisSeverity of Illness IndexSkin CreamSpainStatistics, NonparametricTreatment Outcomeresearch article30022544open access10.1111/jdv.151851468-3083PMC6585804https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jdv.15185https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585804/pdf