title: Verapamil is Less Effective than Triamcinolone for Prevention of Keloid Scar Recurrence After Excision in a Randomized Controlled Trial.
abstract: A double-blind randomized controlled trial with a paired split-scar design compared verapamil, an L-type Ca2+ channel antagonist, and triamcinolone for prevention of keloid recurrence after excision. Ca2+ channel blocking activity of verapamil in keloid cells was explored. One keloid was excised per subject and each wound half randomized to receive intralesional injections of triamcinolone (10 mg/ml) or verapamil (2.5 mg/ml) at monthly intervals (4 doses). Interim analysis was performed after 14 subjects were completed. Survival analysis demonstrated significantly higher keloid recurrence with verapamil compared to triamcinolone 12 months post-surgery (log-rank test, p = 0.01) and higher overall risk of recurrence with verapamil (hazard ratio 8.44, 95% CI 1.62-44.05). The study was terminated early according to the stopping guideline (p < 0.05). Verapamil is safe but not as effective as triamcinolone in preventing keloid recurrence after excision. Further study is necessary to determine if clinical response to verapamil is linked to modulation of intracellular Ca2+.
authors.affiliation: Department of Dermatology, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Danielsen
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Rea
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Wood
authors.forename: Mark W
authors.initials: MW
authors.lastname: Fear
authors.forename: Helena M
authors.initials: HM
authors.lastname: Viola
authors.forename: Livia C
authors.initials: LC
authors.lastname: Hool
authors.forename: Thilanee U
authors.initials: TU
authors.lastname: Gankande
authors.forename: Mansour
authors.initials: M
authors.lastname: Alghamdi
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Stevenson
authors.forename: Mitali
authors.initials: M
authors.lastname: Manzur
authors.forename: Hilary J
authors.initials: HJ
authors.lastname: Wallace
mesh_terms: D000293:Adolescent; D000328:Adult; D002921:Cicatrix / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D015552:Injections, Intralesional; D007627:Keloid / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D014700:Verapamil / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D005938:Glucocorticoids; D014665:Vasodilator Agents; D014700:Verapamil; D014222:Triamcinolone Acetonide