The European Medicines Agency Approval of Ingenol Mebutate (picato) for the Cutaneous Treatment of Non-Hyperkeratotic, Non-Hypertrophic Actinic Keratosis in Adults: Summary of the Scientific Assessment of the Committee for Medicinal Products for Human Use (Chmp)

Background The European Commission has recently issued a marketing authorisation valid throughout the European Union for ingenol mebutate (Picato) in the cutaneous treatment of non-hyperkeratotic, non-hypertrophic actinic keratosis in adults. Objectives The objective of this paper is to summarise the scientific review of the application leading to regulatory approval in the EU. The full scientific assessment report and product information, including the summary of product characteristics, are available on the EMA website (www.ema.europa.eu). Material & Methods The application was supported by 25 clinical studies, of which 18 were performed in patients with actinic keratosis. Results The active substance is a pure ingenol angelate obtained from the aerial parts of the plant species Euphorbia peplus by extraction and purification. One tube of ingenol mebutate 150 mcg/g gel or 500 mcg/g gel should be applied once daily to the affected area for 3 or 2 consecutive days on the ‘face and scalp’ or ‘trunk and extremities’, respectively. Complete response rate is 42.2% on the ‘face and scalp’ and 34.1% on the ‘trunk and extremities’. The most common side effects are local skin responses including erythema, flaking/scaling, crusting, swelling, vesiculation/pustulation and erosion/ulceration at the application site. Conclusions The benefits of ingenol mebutate are its ability to improve the complete response rate of actinic keratosis, the short duration of treatment and the ease of self-application.