Narrowband UVB Phototherapy Another Vital Component to Psoriasis Treatment
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What psoriasis treatment is as effective as adalimumab but achieves better overall improvement in health-related quality of life, as well as improves patient report of pain, lowers markers of systemic inflammation that cause cardiovascular disease, improves levels of HDL (ie, good cholesterol) and requires no laboratory screening?
The answer: narrowband UVB phototherapy! Surprised? So was I, but these data are from the Vascular Inflammation in Psoriasis trial, a randomized placebo-controlled trial we conducted to determine the impact of adalimumab vs. phototherapy vs. placebo on biomarkers of cardiovascular disease. (For a summary of these studies, check out Impact of Biological Agents on Imaging and Biomarkers of Cardiovascular Disease in Patients with Psoriasis: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials).
Clinically, phototherapy remains a valuable treatment in the management of psoriasis that is often preferred by patients who want to avoid pharmaceutical management of their disease. Having an optimal dosing regimen is critical for success. Recently we (the AAD/NPF psoriasis guidelines committee) increased the recommended dosage of narrowband UVB phototherapy for psoriasis in order to improve efficacy while reducing the cumulative dose of UVB radiation needed to achieve skin clearance, so it’s important for clinicians to keep up-to-date with current recommendations.
Other forms of phototherapy are especially helpful for stubborn localized lesions (excimer laser) or palmer plantar variants of psoriasis (topical psoralen plus ultraviolet A, or PUVA). In order to provide comprehensive care for the psoriasis patient, access to phototherapy remains vital.
The biggest limitation of phototherapy is its inconvenience. We are trying to address this issue through the light treatment effectiveness (LITE) study, a pragmatic, randomized trial of home vs. office phototherapy for patients aged 12 years or older with plaque or guttate psoriasis embedded in routine clinical care at 35 dermatology offices in the U.S. (NCT03726489). The study is stratified by skin type in order to test the comparative effectiveness in patients with fair, medium and dark complected skin, with a total enrollment goal of 1,050 patients.
Ultimately, the goal of this study is to make phototherapy more patient-centered whether delivered at home or the office by using the findings to guide clinical practice. Interested in this research? Come join us by visiting www.thelitestudy.com.
- References:
- Elmets CA, et al. J Am Acad Dermatol. 2019; doi:10.1016/j.jaad.2019.04.042.
- González-Cantero A, et al. J Invest Dermatol. 2021;doi:10.1016/j.jid.2021.03.024.
- Mehta NN, et al. Circ Cardiovasc Imaging. 2018; doi:10.1161/CIRCIMAGING.117.007394.
- Noe MH, et al. J Am Acad Derm. 2019;doi:10.1016/j.jaad.2019.05.080.
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