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Greater QoL, pain improvement in psoriasis with phototherapy vs. adalimumab

Adalimumab and phototherapy for psoriasis are both associated with statistically significant improvements in patient-reported outcomes after 12 weeks, but phototherapy yields greater improvement in quality of life and pain, according to recent study findings.

“Our study shows that phototherapy alone not only improves skin-related quality of life (based on the Dermatology Life Quality Index) in psoriasis patients but also improves general health-related quality of life (based on the EQ-5D-3EL),” Megan H. Noe, MD, MPH, MSCE, of the department of dermatology, University of Pennsylvania Perelman School of Medicine, and colleagues wrote in Journal of the American Academy of Dermatology.

There is currently little data comparing phototherapy monotherapy with other active comparators, according to researchers.

The multicenter, randomized, placebo-controlled trial included 97 adult patients randomly assigned in a 1:1:1 ratio to adalimumab (Humira, AbbVie) injections, placebo injections or narrowband ultraviolet B (NB-UVB) phototherapy. Phototherapy was administered three times weekly. The researchers based the dosing estimates on an estimated minimal erythema dose and Fitzpatrick skin type using a modified protocol.

At baseline, the mean Dermatology Life Quality Index (DLQI) scores were 12.13, 13.67 and 12.79 in the placebo, adalimumab and phototherapy groups, respectively.

The EQ-5D-3L is a widely used measure of overall health, which covers the dimensions of mobility, self-care, usual activities, pain and anxiety, according to the researchers. The second part of this measurement is the visual analogue scale (EQ-VAS) in which the patients mark their health status ranging from 0 to 100, with a higher score representing a better quality of life.

At baseline, the mean EQ-VAS scores were 67.58 in the placebo group, 53.38 in the adalimumab group and 54.86 in the phototherapy group.

According to the DLQI after 12 weeks, patients in all three treatment groups achieved statistically significant improvements in skin-related health-related quality of life.

The mean change score was higher in the adalimumab group compared with placebo (–3.8; 95% CI, –7.64 to 0.04) and also higher in the phototherapy group vs. the change in the placebo group (OR = – 4.8; 95% CI, –8.67 to –0.93).

Researchers found no difference in the change score when comparing the phototherapy group and adalimumab group (OR = –1; 95% CI, –4.81 to 2.81). They also found no difference between the mean change score in phototherapy vs. adalimumab with the EQ-5D Index (0.8; 95% CI, –0.02 to 0.18) or EQ-VAS (OR = –1.66; 95% CI, –20.53 to 17.21).

Within the pain domain, phototherapy was the only group compared with placebo to reach statistical significance of having “no problems vs. any problems” (OR = 5.97; 95% CI, 1-95-18.33).

“Surprisingly, phototherapy also significantly improved symptoms of pain in patients with psoriasis, a new finding for a treatment that has been used for decades,” Noe and colleagues wrote.

The researchers are conducting a large-scale pragmatic trial in psoriasis of home- vs office-based narrowband phototherapy. – by Abigail Sutton

Disclosures: Noe reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.