Evaluation of Safety and Efficacy of BF-200 ALA for the Treatment of Actinic Keratosis With Photodynamic Therapy

A Randomized, Observer Blind, Multinational Phase III Study to Evaluate the Safety and Efficacy of a Nanoemulsion Gel Formulation BF-200 ALA, in Comparison With Metvix® and Placebo, for the Treatment of Actinic Keratosis With PDT

Status

Completed

Phases

Phase 3

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT02799069

Enrollment

571

Registered

2016-06-14

Start date

2008-04-30

Completion date

2009-08-31

Last updated

2017-04-28

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Actinic Keratosis

Brief summary

The aim of the study is to evaluate the non-inferiority of BF-200 ALA (Ameluz) in the treatment of actinic keratosis (AK) with photodynamic therapy (PDT) compared to Metvix.

Detailed description

This was a randomized, observer-blind, multinational, comparator and placebo-controlled parallel group, (3:3:1 ratio) study to compare the efficacy and safety of BF-200 ALA with the comparator Metvix® (methyl-\[5-amino-4-oxopentanoate\]) and placebo, for the treatment of AK with PDT.

Interventions

DRUGBF-200 ALA

topical treatment for photodynamic therapy combining drug application and after a 3 h incubation subsequent illumination with a broad or narrow spectrum light source.

DRUGMAL Cream

topical treatment for photodynamic therapy combining drug application and after a 3 h incubation subsequent illumination with a broad or narrow spectrum light source.

DRUGVehicle

topical treatment for photodynamic therapy combining vehicle application and after a 3 h incubation subsequent illumination with a broad or narrow spectrum light source.

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

SINGLE (Outcomes Assessor)

Eligibility

Sex/Gender

ALL

Age

18 Years to 85 Years

Healthy volunteers

Inclusion criteria

Main Inclusion Criteria: * Written informed consent. * Men and women between 18 and 85 years of age. * 4-8 AK lesions of 0.5 to 1.5 cm diameter of mild to moderate intensity (Olsen grade 1 and 2) in the face and/or on the bald scalp. Lesions on the eyes, nostrils, ears and mouth were not considered for treatment during the planned study. * Target AK lesions were to be discrete and quantifiable; adjacent AK lesions were to show a minimum distance of 1.0 cm from one another. * Confirmation of AK by biopsy taken at screening. * Free of significant physical abnormalities (e.g., tattoos, dermatoses) in the potential treatment region that could have caused difficulty with examination or final evaluation. * Willingness to stop the use of moisturizers and any other topical treatments within the treatment region. * Good general health condition. * Healthy subjects and subjects with clinically stable medical conditions including, but not limited to the following diseases (controlled hypertension, diabetes mellitus type II, hypercholesterolemia, osteoarthritis) were permitted to be included in the study if the medication taken for the treatment of the disease did not match an exclusion criterion or was not specified as prohibited concomitant medication. * No extensive sunbathing or solarium use during the trial. * Negative pregnancy test at screening. Main

Exclusion criteria

* Known hypersensitivity to BF-200 ALA, MAL (methyl-aminolevulinic acid) and/or any of the ingredients of the formulations * Clinically significant medical conditions (tumor disease etc.) making implementation of the protocol or interpretation of the study results difficult * Presence of photodermatoses * Presence of other tumors in the treatment areas within the last 4 weeks * Start of treatment with phototoxic or photoallergic drugs within 8 weeks prior to screening * Current treatment with immunosuppression therapy * Hypersensitivity to porphyrins * Presence of porphyria * Presence of inherited or acquired coagulation defect * Any topical treatment within the treatment area within 12 weeks before PDT1 (first PDT Treatment) * Topical treatment with ALA or MAL outside the treatment area during participation in the study * None of the specified systemic treatments within the designated period before PDT1

Design outcomes

Primary

Measure	Time frame	Description
Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT), ITT	12 weeks after the last PDT, up to 24 weeks after the first treatment	An overall complete responder was defined as a subject in whom all treated lesions were cleared (all lesions showing complete remission) 12 weeks after the last PDT. The outcome measure considered complete responders who were completely cleared 12 weeks after the first PDT and responders who were completely cleared 12 weeks after the second PDT if a re-treatment was necessary (in case of partial- or non-responding lesions 12 weeks after the first PDT)
Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT), PP	12 weeks after the last PDT, up to 24 weeks after the first treatment	An overall complete responder was defined as a subject in whom all treated lesions were cleared (all lesions showing complete remission) 12 weeks after the last PDT. The outcome measure considered complete responders who were completely cleared 12 weeks after the first PDT and responders who were completely cleared 12 weeks after the second PDT if a re-treatment was necessary (in case of partial- or non-responding lesions 12 weeks after the first PDT)
Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT) Illuminated With Narrow Spectrum Devices Only	12 weeks after the last PDT, up to 24 weeks after the first treatment	Subgroup analysis of patients treated with a narrow spectrum device for PDT Illumination (\ 630 nm). An overall complete responder was defined as a subject in whom all treated lesions were cleared (all lesions showing complete remission) 12 weeks after the last PDT. The outcome measure considered complete responders who were completely cleared 12 weeks after the first PDT and responders who were completely cleared 12 weeks after the second PDT if a re-treatment was necessary (in case of partial- or non-responding lesions 12 weeks after the first PDT)

Secondary

Measure	Time frame	Description
Percentage of Participants With Complete Response 12 Weeks After Second Photodynamic Therapy (PDT)	12 weeks after the second PDT, 24 weeks after first treatment	A complete responder was defined as a subject in whom all treated lesions were cleared (all lesions showing complete remission) at 12 weeks after the second PDT. A second PDT was applied in case partial- or non-responding lesions remained 12 weeks after the first PDT.
Percentage of Participants With Complete Response 3-4 Weeks After Last Photodynamic Therapy (PDT)	3-4 weeks after the last PDT, up to 16 weeks after the first treatment	A complete responder at week 3-4 after treatment was defined as a subject in whom all treated lesions were cleared (all lesions showing complete remission). This outcome measure considered patients who were completely cleared at 3-4 weeks after the last PDT which included complete responders 3-4 weeks after the first and complete responders 3-4 weeks after the second PDT ( a second PDT was applied in case of remaining lesions 12 weeks after the first PDT).
Percentage of Participants With Partial Response at 3-4 Weeks After First Photodynamic Therapy (PDT)	3-4 weeks after the first PDT	A partial responder was defined as a subject in whom at least 75% of the treated lesions were cleared (lesions showing complete remission). This outcome measure considers partial responders at 3-4 weeks after the first PDT.
Percentage of Participants With Partial Response at 12 Weeks After the First Photodynamic Therapy (PDT)	12 weeks after the first PDT	A partial responder was defined as a subject in whom at least 75% of the treated lesions were cleared (lesions showing complete remission). This outcome measure considers partial responders at 12 weeks after the first PDT.
Percentage of Participants With Partial Response at 3-4 Weeks After the Second Photodynamic Therapy (PDT)	3-4 weeks after the second PDT, 15-16 weeks after first treatment	A partial responder was defined as a subject in whom at least 75% of the treated lesions were cleared (lesions showing complete remission). This outcome measure considers partial responders at 3-4 weeks after the second PDT. A second PDT was applied in case of partial- or non-responding lesions 12 weeks after the first PDT.
Percentage of Participants With Partial Response at 12 Weeks After the Second Photodynamic Therapy (PDT)	12 weeks after the second PDT, 24 weeks after first treatment	A partial responder was defined as a subject in whom at least 75% of the treated lesions were cleared (lesions showing complete remission). This outcome measure considers partial responders at 12 weeks after the second PDT. A second PDT was applied in case of partial- or non-responding lesions 12 weeks after the first PDT.
Percentage of Participants With Partial Response at 3-4 Weeks After Last Photodynamic Therapy (PDT)	3-4 weeks after the last PDT, up to 16 weeks after the first treatment	A partial responder was defined as a subject in whom at least 75% of the treated lesions were cleared (lesions showing complete remission). This outcome measure considers partial responders at 3-4 weeks after last PDT. The outcome measure combined partial responders with at least 75% of lesions cleared at 3-4 weeks after the first PDT or after the second PDT (a second PDT was applied in case of partial- or non-responding lesions 12 weeks after the first PDT).
Percentage of Participants With Partial Response at 12 Weeks After Last Photodynamic Therapy (PDT)	12 weeks after the last PDT, up to 24 weeks after first treatment	A partial responder was defined as a subject in whom at least 75% of the treated lesions were cleared (lesions showing complete remission). This outcome measure considers partial responders at 12 weeks after last PDT. The outcome measure combined partial responders with at least 75% of lesions cleared at 12 weeks after the first PDT and after the second PDT (a second PDT was applied in case of partial- or non-responding lesions 12 weeks after the first PDT) .
Complete Lesion Response Rate 3-4 Weeks After First Photodynamic Therapy (PDT)	3-4 weeks after the first PDT	Completely cleared individual lesions as defined at 3-4 weeks after first photodynamic therapy (PDT)
Complete Lesion Response Rate 12 Weeks After First Photodynamic Therapy (PDT)	12 weeks after the first PDT	Completely cleared individual lesions as defined at 12 weeks after the first photodynamic therapy (PDT).
Complete Lesion Response Rate 3-4 Weeks After the Second Photodynamic Therapy (PDT)	3-4 weeks after the second PDT, 15-16 weeks after first treatment	Completely cleared individual lesions as defined at 3-4 weeks after the second PDT. A second PDT was applied in case the individual lesion showed no or partial response12 weeks after first PDT.
Complete Lesion Response Rate 12 Weeks After Second PDT	12 weeks after the second PDT, 24 weeks after first treatment	Completely cleared individual lesions as defined at 12 weeks after second PDT. A second PDT was applied in case the individual lesion showed no or partial response 12 weeks after first PDT.
Complete Lesion Response Rate 3-4 Weeks After Last Photodynamic Therapy (PDT)	3-4 weeks after the last PDT, up to 16 weeks after first treatment	Completely cleared individual lesions defined at 3-4 weeks after the last PDT comprising of completely cleared individual lesions 3-4 weeks after the first and after the second PDT (a second PDT was applied in case lesions show no or partial response 12 weeks after the first PDT).
Complete Lesion Response Rate 12 Weeks After Last Photodynamic Therapy (PDT)	12 weeks after the last PDT, up to 24 weeks after first treatment	Completely cleared individual lesions 12 weeks after last PDT comprising of completely cleared individual lesions 12 weeks after the first or second PDT (a second PDT was applied in case individual lesions show no or partial response 12 weeks after first PDT).
Percentage of Participants With Complete Response 3-4 Weeks After First Photodynamic Therapy (PDT)	3-4 weeks after the first PDT	A complete responder was defined as a subject in whom all treated lesions were cleared (all lesions showing complete remission) at 3-4 weeks after the first PDT.
Change From Baseline in Total Lesion Area 3-4 Weeks After the First Photodynamic Therapy (PDT)	3-4 weeks after the first PDT	Percentage of change from baseline in the lesion area of all treated lesions per subject (summation of sizes of all treated lesions) assessed at 3-4 weeks after the first PDT.
Change From Baseline in Total Lesion Area 12 Weeks After the First Photodynamic Therapy (PDT)	12 weeks after the first PDT	the change from baseline in the lesion area of all treated lesions per subject (summation of sizes of all treated lesions) assessed 12 weeks after the first PDT.
Change From Baseline in Total Lesion Area 3-4 Weeks After the Second Photodynamic Therapy (PDT)	3-4 weeks after the second PDT, 15-16 weeks after first treatment	the change from baseline in the lesion area of all treated lesions per subject (summation of sizes of all treated lesions) assessed 3-4 weeks after the second PDT. A second PDT was applied in case of non or partially responding lesions 12 weeks after first PDT.
Change From Baseline in Total Lesion Area 12 Weeks After Second Photodynamic Therapy (PDT)	12 weeks after the second PDT, 24 after first treatment	the change from baseline in the lesion area of all treated lesions per subject (summation of sizes of all treated lesions) assessed 12 weeks after the second PDT. A second PDT was applied in case of non- or partially responding lesions 12 weeks after first PDT.
Change From Baseline in Total Lesion Area 3-4 Weeks After Last Photodynamic Therapy (PDT)	3-4 weeks after the last PDT, up to 16 weeks after the first treatment	the change from baseline in the lesion area of all treated lesions per subject (summation of sizes of all treated lesions) assessed at 3-4 weeks after last PDT, combining the changes from baseline in total lesion area of subjects 3-4 weeks after first PDT and second PDT (a second PDT was applied for subjects who showed non- or partially responding lesions 12 weeks after the first PDT).
Change From Baseline in Total Lesion Area 12 Weeks After Last Photodynamic Therapy (PDT)	12 weeks after the last PDT, up to 24 weeks after the first treatment	the change from baseline in the lesion area of all treated lesions per subject (summation of sizes of all treated lesions) assessed at 12 weeks after last PDT, combining the changes from baseline in total lesion area at 12 weeks after the first PDT and at 12 weeks after the second PDT (a second PDT was applied to subjects with non- or partially responding lesions 12 weeks after the first PDT).
Overall Cosmetic Outcome of the Treated Skin 12 Weeks After Last Photodynamic Therapy (PDT) Compared to Baseline	12 weeks after the last PDT, up to 24 weeks after first treatment	The cosmetic outcome 12 weeks after the last PDT (12 weeks after 1st PDT for subjects who are completely cleared at this time point, 12 weeks after 2nd PDT for subjects retreated due to remaining lesions 12 weeks after 1st PDT) will be calculated on the basis of the skin quality assessment (skin surface, hyperpigmentation, hypopigmentation, mottled or irregular pigmentation, degree of scarring, and atrophy) upon visual examination (scale: 0= none, 1= mild, 2= moderate, 3=severe). The cosmetic outcome is rated as very good if the sum score of the previously mentioned ratings (all ratings for each sign added up) has improved by at least 2 points as compared to baseline; as good if the sum score has improved by at least 1 point as compared to baseline; as satisfactory if the sum score is identical to the one at baseline; as unsatisfactory if the sum score has worsened by 1 point compared to baseline and as impaired if the sum score has worsened by at least 2 points compared to baseline.
Local Skin Reactions During First Photodynamic Therapy (PDT-1)	during PDT treatment [3 h - 4 h ]	Local skin reactions in the treatment area as assessed by the investigator during the first PDT (PDT-1)
Local Skin Reactions During Second Photodynamic Therapy (PDT-2) for Retreated Subjects	during PDT treatment [3 h - 4 h ]	Local skin reactions in the treatment area as assessed by the investigator during PDT-2; only applicable for subjects who were retreated with a second PDT due to remaining lesions 12 weeks after the first PDT (subjects with data).
Local Discomfort During First Photodynamic Therapy (PDT-1)	during PDT treatment [3 h - 4 h ]	Local discomfort reported by the patients during Illumination of first PDT (PDT1)
Local Discomfort During Second Photodynamic Therapy (PDT-2) for Retreated Subjects	during PDT treatment [3 h - 4 h ]	Local discomfort reported by the patients during Illumination phase of retreatment (PDT-2); only applicable for subjects who received a retreatment (PDT-2) due to remaining lesions 12 weeks after the first treatment (PDT-1) (subjects with data)
Local Discomfort - Pain During First Photodynamic Therapy (PDT-1)	during PDT treatment [3 h - 4 h ]	Pain (11-point numeric rating scale) by PDT Session; Overall (If both areas have been treated, maximum intensity over both areas is used for analysis.) Patients assessed the pain experienced during PDT using an 11-point numeric rating pain scale (NRPS) ranging from 0 (no pain at all) to 10 (worst possible pain). This score reflects the patient's maximum pain during PDT. This outcome measure shows pain score after the first PDT.
Local Discomfort - Pain During Second Photodynamic Therapy (PDT-2) for Retreated Subjects	during PDT treatment [3 h - 4 h ]	Pain (11-point numeric rating scale) by PDT Session; Overall (If both areas have been treated, maximum intensity over both areas is used for analysis.) Patients assessed the pain experienced during PDT using an 11-point numeric rating pain scale (NRPS) ranging from 0 (no pain at all) to 10 (worst possible pain). This score reflects the patient's maximum pain during PDT. Only applicable for subjects who received a retreatment (PDT-2) due to remaining lesions 12 weeks after the first treatment (PDT-1) (subjects with data)
Adverse Reactions	up to 12 weeks after the last PDT, up to 24 weeks after first treatment	Adverse reactions are Treatment-Emergent Adverse Events considered at least possibly related to the treatment with the randomized investigational medicinal products; Adverse reactions are shown with a frequency cut off of \>=5%. TEAEs are considered from subjects who received only one PDT or subjects who received 2 PDTs (initial Treatment (PDT-1) and retreatment (PDT-2) due to remaining lesions 12 weeks after first photodynamic therapy. The safety set consists of all patients treated at least once with investigational product. Treatment with investigational product consists of application of study drug followed by illumination. This excludes one patient from the safety set; for this patient the investigational product was applied on the skin but it was not illuminated. Patients are treated according to actual treatment.
Complete Lesion Response Rates 12 Weeks After Last Photodynamic Therapy (PDT) Illuminated With Narrow Spectrum Devices Only	up to 12 weeks after the last PDT, up to 24 weeks after first treatment	Completely cleared individual lesions 12 weeks after last PDT comprising of individual cleared lesions 12 weeks after the first or second PDT. A second PDT was applied in case individual lesion showed no or partial response 12 weeks after the first PDT. Lesions were illuminated during photodynamic therapy with narrow spectrum devices only (\ 630 nm).
Percentage of Participants With Complete Response 12 Weeks After First Photodynamic Therapy (PDT)	12 weeks after the first PDT	A complete responder was defined as a subject in whom all treated lesions were cleared (all lesions showing complete remission) at 12 weeks after the first PDT.
Percentage of Participants With Complete Response 3-4 Weeks After the Second Photodynamic Therapy (PDT)	3-4 weeks after the second PDT, 15-16 weeks after first treatment	A complete responder was defined as a subject in whom all treated lesions were cleared (all lesions showing complete remission) at 3-4 weeks after the second PDT. A second PDT was applied in case partial- or non-responding lesions remained 12 weeks after the first PDT.

Participant flow

Recruitment details

Multinational / 26 centers sites: Germany (23), Austria (2) and Switzerland (1); 08 Apr 2008: First subject signed informed consent; 21 Aug 2009: Last subject completed clinical part of study

Pre-assignment details

616 patients with actinic keratosis (AK) were planned to be randomized in a 3:3:1 ratio allowing for 20% of non-evaluable patients excluded from the per-protocol set. Due to the low drop out rates, recruiting was stopped after 600 patients were screened. Of those, 571 patients were randomized and 29 patients were screening failures.

Participants by arm

Arm	Count
Vehicle Topical application of BF-200 ALA matched placebo gel without active ingredient. Application of a 1 mm thick layer covering each lesion and a 0.5 cm to 1 cm surrounding margin. BF-200 ALA matched placebo: topical treatment for photodynamic therapy combining vehicle application and after a 3 h incubation subsequent illumination with a broad or narrow spectrum light source.	76
BF-200 ALA Topical application of BF-200 ALA gel containing 78 mg/g 5-aminolevulinic acid (ALA). Application of a 1 mm thick layer covering each lesion and a 0.5 cm to 1 cm surrounding margin. BF-200 ALA: topical treatment for photodynamic therapy combining drug application and after a 3 h incubation subsequent illumination with a broad or narrow spectrum light source.	248
MAL Cream Topical application of MAL cream (Metvix) containing 160 mg/g methyl-aminolevulinate (MAL). Application of a 1 mm thick layer covering each lesion and a 0.5 cm to 1 cm surrounding margin. MAL: topical treatment for photodynamic therapy combining drug application and after a 3 h incubation subsequent illumination with a broad or narrow spectrum light source.	246
Total	570

Withdrawals & dropouts

Period	Reason	FG000	FG001	FG002
Overall Study	Adverse Event	0	2	2
Overall Study	Lack of Efficacy	2	0	0
Overall Study	Lost to Follow-up	1	1	0
Overall Study	Protocol Violation	1	0	2
Overall Study	Withdrawal by Subject	4	4	3

Baseline characteristics

Characteristic	Vehicle	BF-200 ALA	MAL Cream	Total
Age, Categorical <=18 years	0 Participants	0 Participants	0 Participants	0 Participants
Age, Categorical >=65 years	67 Participants	201 Participants	208 Participants	476 Participants
Age, Categorical Between 18 and 65 years	9 Participants	47 Participants	38 Participants	94 Participants
Age, Continuous	71.5 years STANDARD_DEVIATION 6.68	70.2 years STANDARD_DEVIATION 7.18	71.0 years STANDARD_DEVIATION 6.93	70.7 years STANDARD_DEVIATION 7.01
Number of individual lesions	490 individual lesions	1504 individual lesions	1557 individual lesions	3551 individual lesions
Region of Enrollment Europe	76 participants	248 participants	246 participants	570 participants
Sex: Female, Male Female	16 Participants	34 Participants	41 Participants	91 Participants
Sex: Female, Male Male	60 Participants	214 Participants	205 Participants	479 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk	EG002 affected / at risk
deaths Total, all-cause mortality	— / —	— / —	— / —
other Total, other adverse events	55 / 76	239 / 248	241 / 246
serious Total, serious adverse events	3 / 76	11 / 248	10 / 246

Outcome results

Primary

Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT) Illuminated With Narrow Spectrum Devices Only

Subgroup analysis of patients treated with a narrow spectrum device for PDT Illumination (\ 630 nm). An overall complete responder was defined as a subject in whom all treated lesions were cleared (all lesions showing complete remission) 12 weeks after the last PDT. The outcome measure considered complete responders who were completely cleared 12 weeks after the first PDT and responders who were completely cleared 12 weeks after the second PDT if a re-treatment was necessary (in case of partial- or non-responding lesions 12 weeks after the first PDT)

Time frame: 12 weeks after the last PDT, up to 24 weeks after the first treatment

Population: ITT

Arm	Measure	Value (NUMBER)
Vehicle	Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT) Illuminated With Narrow Spectrum Devices Only	12.8 percentage of patients
BF-200 ALA	Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT) Illuminated With Narrow Spectrum Devices Only	84.8 percentage of patients
MAL Cream	Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT) Illuminated With Narrow Spectrum Devices Only	67.5 percentage of patients

p-value: 095% CI: [59.7, 84.2]Chi-squared

Primary

Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT), ITT

An overall complete responder was defined as a subject in whom all treated lesions were cleared (all lesions showing complete remission) 12 weeks after the last PDT. The outcome measure considered complete responders who were completely cleared 12 weeks after the first PDT and responders who were completely cleared 12 weeks after the second PDT if a re-treatment was necessary (in case of partial- or non-responding lesions 12 weeks after the first PDT)

Time frame: 12 weeks after the last PDT, up to 24 weeks after the first treatment

Population: Intent-to-treat (ITT)

Arm	Measure	Value (NUMBER)
Vehicle	Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT), ITT	17.1 percentage of patients
BF-200 ALA	Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT), ITT	78.2 percentage of patients
MAL Cream	Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT), ITT	64.2 percentage of patients

Comparison: Superiority of BF-200 ALA compared to placebo:~A sample size of 264: 88 patients (BF-200 ALA: placebo) will have a power of more than 90% to establish superiority of BF-200 ALA over placebo, even if very conservative response rates of 65% for the BF-200 ALA group and 40% for placebo are assumed using a chi-square test with continuity correction and a two-sided significance level of 0.05.p-value: 095% CI: [51.2, 71]Chi-squared

Primary

Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT), PP

Time frame: 12 weeks after the last PDT, up to 24 weeks after the first treatment

Population: per protocol set (PP)

Arm	Measure	Value (NUMBER)
Vehicle	Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT), PP	20.0 percentage of patients
BF-200 ALA	Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT), PP	79.4 percentage of patients
MAL Cream	Percentage of Participants With Complete Response 12 Weeks After the Last Photodynamic Therapy (PDT), PP	65.3 percentage of patients

p-value: 095% CI: [48.4, 70.4]Chi-squared

Secondary

Adverse Reactions

Adverse reactions are Treatment-Emergent Adverse Events considered at least possibly related to the treatment with the randomized investigational medicinal products; Adverse reactions are shown with a frequency cut off of \>=5%. TEAEs are considered from subjects who received only one PDT or subjects who received 2 PDTs (initial Treatment (PDT-1) and retreatment (PDT-2) due to remaining lesions 12 weeks after first photodynamic therapy. The safety set consists of all patients treated at least once with investigational product. Treatment with investigational product consists of application of study drug followed by illumination. This excludes one patient from the safety set; for this patient the investigational product was applied on the skin but it was not illuminated. Patients are treated according to actual treatment.

Time frame: up to 12 weeks after the last PDT, up to 24 weeks after first treatment

Population: safety population

Arm	Measure	Group	Value (COUNT_OF_PARTICIPANTS)
Vehicle	Adverse Reactions	Application site irritation	25 Participants
Vehicle	Adverse Reactions	Application site scab	2 Participants
Vehicle	Adverse Reactions	Application site erythema	31 Participants
Vehicle	Adverse Reactions	Application site pain	19 Participants
Vehicle	Adverse Reactions	Application site edema	1 Participants
Vehicle	Adverse Reactions	Application site pruritus	6 Participants
Vehicle	Adverse Reactions	Application site induration	0 Participants
Vehicle	Adverse Reactions	Application site vesicles	1 Participants
Vehicle	Adverse Reactions	Application site paraesthesia	2 Participants
Vehicle	Adverse Reactions	Skin exfoliation	1 Participants
Vehicle	Adverse Reactions	Application site exfoliation	5 Participants
BF-200 ALA	Adverse Reactions	Skin exfoliation	17 Participants
BF-200 ALA	Adverse Reactions	Application site irritation	219 Participants
BF-200 ALA	Adverse Reactions	Application site edema	62 Participants
BF-200 ALA	Adverse Reactions	Application site induration	24 Participants
BF-200 ALA	Adverse Reactions	Application site scab	27 Participants
BF-200 ALA	Adverse Reactions	Application site exfoliation	44 Participants
BF-200 ALA	Adverse Reactions	Application site pruritus	59 Participants
BF-200 ALA	Adverse Reactions	Application site paraesthesia	17 Participants
BF-200 ALA	Adverse Reactions	Application site erythema	198 Participants
BF-200 ALA	Adverse Reactions	Application site vesicles	22 Participants
BF-200 ALA	Adverse Reactions	Application site pain	175 Participants
MAL Cream	Adverse Reactions	Application site paraesthesia	18 Participants
MAL Cream	Adverse Reactions	Application site pain	179 Participants
MAL Cream	Adverse Reactions	Application site edema	61 Participants
MAL Cream	Adverse Reactions	Skin exfoliation	15 Participants
MAL Cream	Adverse Reactions	Application site induration	21 Participants
MAL Cream	Adverse Reactions	Application site vesicles	23 Participants
MAL Cream	Adverse Reactions	Application site exfoliation	44 Participants
MAL Cream	Adverse Reactions	Application site pruritus	60 Participants
MAL Cream	Adverse Reactions	Application site scab	30 Participants
MAL Cream	Adverse Reactions	Application site irritation	222 Participants
MAL Cream	Adverse Reactions	Application site erythema	199 Participants

Secondary

Change From Baseline in Total Lesion Area 12 Weeks After Last Photodynamic Therapy (PDT)

the change from baseline in the lesion area of all treated lesions per subject (summation of sizes of all treated lesions) assessed at 12 weeks after last PDT, combining the changes from baseline in total lesion area at 12 weeks after the first PDT and at 12 weeks after the second PDT (a second PDT was applied to subjects with non- or partially responding lesions 12 weeks after the first PDT).

Time frame: 12 weeks after the last PDT, up to 24 weeks after the first treatment

Population: ITT

Arm	Measure	Value (MEAN)	Dispersion
Vehicle	Change From Baseline in Total Lesion Area 12 Weeks After Last Photodynamic Therapy (PDT)	-48.5 percentage of change from baseline	Standard Deviation 44.83
BF-200 ALA	Change From Baseline in Total Lesion Area 12 Weeks After Last Photodynamic Therapy (PDT)	-95.0 percentage of change from baseline	Standard Deviation 15.66
MAL Cream	Change From Baseline in Total Lesion Area 12 Weeks After Last Photodynamic Therapy (PDT)	-92.0 percentage of change from baseline	Standard Deviation 17.74

Secondary

Change From Baseline in Total Lesion Area 12 Weeks After Second Photodynamic Therapy (PDT)

the change from baseline in the lesion area of all treated lesions per subject (summation of sizes of all treated lesions) assessed 12 weeks after the second PDT. A second PDT was applied in case of non- or partially responding lesions 12 weeks after first PDT.

Time frame: 12 weeks after the second PDT, 24 after first treatment

Population: ITT

Arm	Measure	Value (MEAN)	Dispersion
Vehicle	Change From Baseline in Total Lesion Area 12 Weeks After Second Photodynamic Therapy (PDT)	-50.1 percentage of change from baseline	Standard Deviation 43.89
BF-200 ALA	Change From Baseline in Total Lesion Area 12 Weeks After Second Photodynamic Therapy (PDT)	-92.3 percentage of change from baseline	Standard Deviation 17.15
MAL Cream	Change From Baseline in Total Lesion Area 12 Weeks After Second Photodynamic Therapy (PDT)	-88.9 percentage of change from baseline	Standard Deviation 19.03

Secondary

Change From Baseline in Total Lesion Area 12 Weeks After the First Photodynamic Therapy (PDT)

the change from baseline in the lesion area of all treated lesions per subject (summation of sizes of all treated lesions) assessed 12 weeks after the first PDT.

Time frame: 12 weeks after the first PDT

Population: ITT

Arm	Measure	Value (MEAN)	Dispersion
Vehicle	Change From Baseline in Total Lesion Area 12 Weeks After the First Photodynamic Therapy (PDT)	-37.0 percentage of change from baseline	Standard Deviation 39.86
BF-200 ALA	Change From Baseline in Total Lesion Area 12 Weeks After the First Photodynamic Therapy (PDT)	-85.4 percentage of change from baseline	Standard Deviation 22.81
MAL Cream	Change From Baseline in Total Lesion Area 12 Weeks After the First Photodynamic Therapy (PDT)	-80.9 percentage of change from baseline	Standard Deviation 27.65

Secondary

Change From Baseline in Total Lesion Area 3-4 Weeks After Last Photodynamic Therapy (PDT)

the change from baseline in the lesion area of all treated lesions per subject (summation of sizes of all treated lesions) assessed at 3-4 weeks after last PDT, combining the changes from baseline in total lesion area of subjects 3-4 weeks after first PDT and second PDT (a second PDT was applied for subjects who showed non- or partially responding lesions 12 weeks after the first PDT).

Time frame: 3-4 weeks after the last PDT, up to 16 weeks after the first treatment

Population: ITT

Arm	Measure	Value (MEAN)	Dispersion
Vehicle	Change From Baseline in Total Lesion Area 3-4 Weeks After Last Photodynamic Therapy (PDT)	-43.8 percentage of change from baseline	Standard Deviation 43.4
BF-200 ALA	Change From Baseline in Total Lesion Area 3-4 Weeks After Last Photodynamic Therapy (PDT)	-89.4 percentage of change from baseline	Standard Deviation 20.13
MAL Cream	Change From Baseline in Total Lesion Area 3-4 Weeks After Last Photodynamic Therapy (PDT)	-86.6 percentage of change from baseline	Standard Deviation 22.57

Secondary

Change From Baseline in Total Lesion Area 3-4 Weeks After the First Photodynamic Therapy (PDT)

Percentage of change from baseline in the lesion area of all treated lesions per subject (summation of sizes of all treated lesions) assessed at 3-4 weeks after the first PDT.

Time frame: 3-4 weeks after the first PDT

Population: ITT

Arm	Measure	Value (MEAN)	Dispersion
Vehicle	Change From Baseline in Total Lesion Area 3-4 Weeks After the First Photodynamic Therapy (PDT)	-26.9 percentage of change from baseline	Standard Deviation 32.74
BF-200 ALA	Change From Baseline in Total Lesion Area 3-4 Weeks After the First Photodynamic Therapy (PDT)	-78.9 percentage of change from baseline	Standard Deviation 27.71
MAL Cream	Change From Baseline in Total Lesion Area 3-4 Weeks After the First Photodynamic Therapy (PDT)	-75.7 percentage of change from baseline	Standard Deviation 27.76

Secondary

Change From Baseline in Total Lesion Area 3-4 Weeks After the Second Photodynamic Therapy (PDT)

the change from baseline in the lesion area of all treated lesions per subject (summation of sizes of all treated lesions) assessed 3-4 weeks after the second PDT. A second PDT was applied in case of non or partially responding lesions 12 weeks after first PDT.

Time frame: 3-4 weeks after the second PDT, 15-16 weeks after first treatment

Population: ITT

Arm	Measure	Value (MEAN)	Dispersion
Vehicle	Change From Baseline in Total Lesion Area 3-4 Weeks After the Second Photodynamic Therapy (PDT)	-46.2 percentage of change from baseline	Standard Deviation 43.16
BF-200 ALA	Change From Baseline in Total Lesion Area 3-4 Weeks After the Second Photodynamic Therapy (PDT)	-91.4 percentage of change from baseline	Standard Deviation 15.83
MAL Cream	Change From Baseline in Total Lesion Area 3-4 Weeks After the Second Photodynamic Therapy (PDT)	-87.5 percentage of change from baseline	Standard Deviation 22.93

Secondary

Complete Lesion Response Rate 12 Weeks After First Photodynamic Therapy (PDT)

Completely cleared individual lesions as defined at 12 weeks after the first photodynamic therapy (PDT).

Time frame: 12 weeks after the first PDT

Population: ITT

Arm	Measure	Value (NUMBER)
Vehicle	Complete Lesion Response Rate 12 Weeks After First Photodynamic Therapy (PDT)	24.7 percentage of lesions
BF-200 ALA	Complete Lesion Response Rate 12 Weeks After First Photodynamic Therapy (PDT)	73.8 percentage of lesions
MAL Cream	Complete Lesion Response Rate 12 Weeks After First Photodynamic Therapy (PDT)	66.5 percentage of lesions

Secondary

Complete Lesion Response Rate 12 Weeks After Last Photodynamic Therapy (PDT)

Completely cleared individual lesions 12 weeks after last PDT comprising of completely cleared individual lesions 12 weeks after the first or second PDT (a second PDT was applied in case individual lesions show no or partial response 12 weeks after first PDT).

Time frame: 12 weeks after the last PDT, up to 24 weeks after first treatment

Population: ITT

Arm	Measure	Value (NUMBER)
Vehicle	Complete Lesion Response Rate 12 Weeks After Last Photodynamic Therapy (PDT)	37.1 percentage of lesions
BF-200 ALA	Complete Lesion Response Rate 12 Weeks After Last Photodynamic Therapy (PDT)	90.4 percentage of lesions
MAL Cream	Complete Lesion Response Rate 12 Weeks After Last Photodynamic Therapy (PDT)	83.2 percentage of lesions

Secondary

Complete Lesion Response Rate 12 Weeks After Second PDT

Completely cleared individual lesions as defined at 12 weeks after second PDT. A second PDT was applied in case the individual lesion showed no or partial response 12 weeks after first PDT.

Time frame: 12 weeks after the second PDT, 24 weeks after first treatment

Population: ITT

Arm	Measure	Value (NUMBER)
Vehicle	Complete Lesion Response Rate 12 Weeks After Second PDT	22.0 percentage of lesions
BF-200 ALA	Complete Lesion Response Rate 12 Weeks After Second PDT	69.3 percentage of lesions
MAL Cream	Complete Lesion Response Rate 12 Weeks After Second PDT	58.0 percentage of lesions

Secondary

Complete Lesion Response Rate 3-4 Weeks After First Photodynamic Therapy (PDT)

Completely cleared individual lesions as defined at 3-4 weeks after first photodynamic therapy (PDT)

Time frame: 3-4 weeks after the first PDT

Population: ITT

Arm	Measure	Value (NUMBER)
Vehicle	Complete Lesion Response Rate 3-4 Weeks After First Photodynamic Therapy (PDT)	12.7 percentage of lesions
BF-200 ALA	Complete Lesion Response Rate 3-4 Weeks After First Photodynamic Therapy (PDT)	63.9 percentage of lesions
MAL Cream	Complete Lesion Response Rate 3-4 Weeks After First Photodynamic Therapy (PDT)	58.8 percentage of lesions

Secondary

Complete Lesion Response Rate 3-4 Weeks After Last Photodynamic Therapy (PDT)

Completely cleared individual lesions defined at 3-4 weeks after the last PDT comprising of completely cleared individual lesions 3-4 weeks after the first and after the second PDT (a second PDT was applied in case lesions show no or partial response 12 weeks after the first PDT).

Time frame: 3-4 weeks after the last PDT, up to 16 weeks after first treatment

Population: ITT

Arm	Measure	Value (NUMBER)
Vehicle	Complete Lesion Response Rate 3-4 Weeks After Last Photodynamic Therapy (PDT)	31.4 percentage of lesions
BF-200 ALA	Complete Lesion Response Rate 3-4 Weeks After Last Photodynamic Therapy (PDT)	79.0 percentage of lesions
MAL Cream	Complete Lesion Response Rate 3-4 Weeks After Last Photodynamic Therapy (PDT)	73.5 percentage of lesions

Secondary

Complete Lesion Response Rate 3-4 Weeks After the Second Photodynamic Therapy (PDT)

Completely cleared individual lesions as defined at 3-4 weeks after the second PDT. A second PDT was applied in case the individual lesion showed no or partial response12 weeks after first PDT.

Time frame: 3-4 weeks after the second PDT, 15-16 weeks after first treatment

Population: ITT

Arm	Measure	Value (NUMBER)
Vehicle	Complete Lesion Response Rate 3-4 Weeks After the Second Photodynamic Therapy (PDT)	16.3 percentage of lesions
BF-200 ALA	Complete Lesion Response Rate 3-4 Weeks After the Second Photodynamic Therapy (PDT)	60.4 percentage of lesions
MAL Cream	Complete Lesion Response Rate 3-4 Weeks After the Second Photodynamic Therapy (PDT)	54.8 percentage of lesions

Secondary

Complete Lesion Response Rates 12 Weeks After Last Photodynamic Therapy (PDT) Illuminated With Narrow Spectrum Devices Only

Completely cleared individual lesions 12 weeks after last PDT comprising of individual cleared lesions 12 weeks after the first or second PDT. A second PDT was applied in case individual lesion showed no or partial response 12 weeks after the first PDT. Lesions were illuminated during photodynamic therapy with narrow spectrum devices only (\ 630 nm).

Time frame: up to 12 weeks after the last PDT, up to 24 weeks after first treatment

Population: ITT

Arm	Measure	Value (NUMBER)
Vehicle	Complete Lesion Response Rates 12 Weeks After Last Photodynamic Therapy (PDT) Illuminated With Narrow Spectrum Devices Only	32.5 percentage of lesions
BF-200 ALA	Complete Lesion Response Rates 12 Weeks After Last Photodynamic Therapy (PDT) Illuminated With Narrow Spectrum Devices Only	93.6 percentage of lesions
MAL Cream	Complete Lesion Response Rates 12 Weeks After Last Photodynamic Therapy (PDT) Illuminated With Narrow Spectrum Devices Only	89.3 percentage of lesions

Secondary