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A systematic literature review was conducted to identify and qualitatively assess randomized controlled trials in immunocompetent patients ≥18 years with head-region lesions of actinic keratoses who were treated with field-directed, lesion-directed and other therapies. Network meta-analysis was used to quantitatively evaluate field-directed therapies (5-fluorouracil formulations, diclofenac sodium, imiquimod, ingenol mebutate, 5-aminolevulinic acid or methyl aminolevulinate plus photodynamic therapy) using complete clearance or partial clearance of actinic keratoses lesions, and adverse event-related withdrawals as a proxy of acceptability. Of 2,863 references identified, 75 trials reported in 151 publications were included. In summary, comparative network meta-analysis evaluation showed that 5-FU formulations were the most efficacious interventions examined. 5-FU 4%, which was recently approved, showed a comparable efficacy profile to 5-FU 5%, and had satisfactory acceptability outcomes.

Systematic Literature Review and Network Meta-analysis of the Efficacy and Acceptability of Interventions in Actinic Keratoses