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Nicotinamide Cuts Rate of Nonmelanoma Skin Cancer in Those at High Risk
Key clinical point: Nicotinamide, an inexpensive oral vitamin, protects against nonmelanoma skin cancer in patients at high risk. Major finding:...
COPENHAGEN – Oral nicotinamide markedly reduces transepidermal water loss (TEWL), raising the prospect that it could be effective in the treatment of atopic dermatitis, Dr. Andrew C. Chen reported at the annual congress of the European Academy of Dermatology and Venereology.
“Nicotinamide is safe, accessible over the counter as a vitamin supplement, and inexpensive. It may be a new systemic therapy for conditions with impaired skin barrier function,” according to Dr. Chen of Royal Alfred Hospital in Sydney.
While nicotinic acid, also known as niacin, famously causes vasodilatory side effects including pronounced flushing and headache, nicotinamide is something else altogether: an amide form of vitamin B3 with a well-established safety profile and no vasodilatory side effects, he explained.
Dr. Chen presented a substudy of the phase III double-blind, multicenter, placebo-controlled Oral Nicotinamide to Reduce Actinic Cancer trial (ONTRAC), in which 386 patients with at least two nonmelanoma skin cancers in the previous 5 years were randomized to oral nicotinamide at 500 mg twice daily or placebo for 12 months. This landmark study showed that nicotinamide did indeed reduce the incidence of nonmelanoma skin cancer (N Engl J Med 2015;373:1618-26).
A secondary endpoint in ONTRAC was oral nicotinamide’s effect on skin barrier function as measured by TEWL. Among the 292 ONTRAC participants with standardized TEWL measurements obtained at the forehead, left forearm, and left leg at baseline and every 3 months thereafter, nicotinamide resulted in significantly less TEWL than placebo at every time point after baseline. At the midforehead, for example, TEWL was 5% less than with placebo at 3 months and 6 months, 6% less at 9 months, and 6% less at the 12-month mark. At the forearm and midleg, the difference was 7% at 12 months. Side effects were similar to placebo.
During the course of the 12-month study, TEWL was 15% greater in controls during the Australian winter as compared with summer. Oral nicotinamide essentially reduced TEWL by a magnitude equivalent to roughly half the variation between the extremes of summer and winter, Dr. Chen noted.
The ONTRAC trial was supported by the Australian National Health and Medical Research Council. Dr. Chen reported having no financial conflicts regarding the study.