LITE: Home-based phototherapy as effective as office-based UVB treatment for psoriasis
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Key takeaways:
- Home-based phototherapy treatment of psoriasis was noninferior to office-based treatment.
- The findings were consistent across all skin types.
SAN DIEGO — In a real-world setting, treatment with home-based phototherapy was noninferior to office phototherapy for people with plaque or guttate psoriasis, with both options safe and efficacious, according to a speaker here.
As Healio previously reported, data from the pragmatic, randomized, active comparator Light Treatment Effectiveness (LITE) study also showed that phototherapy treatment for psoriasis was effective regardless of skin type, supporting its use as a potential first-line treatment option.
Phototherapy is proven safe, 10 to 100 times less expensive than biologic therapies and may have cardiovascular benefits for people with psoriasis, Joel M. Gelfand, MD, MSCE, James J. Leyden Professor of Dermatology & Epidemiology at Perelman School of Medicine at the University of Pennsylvania and the study’s principal investigator, said during a late-breaking research presentation at the American Academy of Dermatology Annual Meeting. Yet, home phototherapy is typically not covered by insurance, and many patients who might benefit struggle to travel to an office for phototherapy treatments two to three times per week, the recommended standard of care.
“Many patients want to try phototherapy for psoriasis and want to try it at home, but there is an evidence gap in the United States — limited data on the effectiveness of home phototherapy in psoriasis,” Gelfand, who is also the Healio Dermatology Peer Perspective Board Chief Medical Editor, told Healio. “That is why some of our insurance companies are uncertain about covering it, and some of our colleagues are uncertain about prescribing it.”
Assessing efficacy, quality of life
For the LITE study, Gelfand and colleagues analyzed data from 783 participants (mean age, 48 years; 48% female; 75.1% white) aged 12 years and older with skin types I to IV from 42 dermatology practices across the U.S. Within the cohort, 44.7% had skin types I or II, 44.7% had skin types III or IV and 10.6% had skin types V or VI. Researchers randomly assigned participants 1:1 to 12 weeks of home-based narrowband UVB phototherapy or office-based treatment, comparing the effectiveness, safety and duration of treatment response.
“We had very simple [study] criteria: aged 12 years or older, plaque or guttate psoriasis that the dermatologist thought was appropriate for treatment at home or in-office,” Gelfand said. “There were no exclusions for other treatments; in fact, 12% of the patients were already taking oral or biologic medications during the study. One [study participant] was pregnant. These are the types of patients we never see in efficacy trials for FDA approval. Our goal here was to show how things work in the real world.”
At 12 weeks, researchers found that participants assigned to home- vs. office-based phototherapy were more likely to achieve clear/almost clear skin (32.8% vs. 25.6%; P for noninferiority < .0001) and no to small effect on health-related quality of life (52.4% vs. 33.6%; P for noninferiority < .0001).
In analyses stratified by skin type, findings were similar for participants with fair, medium complected and darkly pigmented skin. As Healio previously reported, topline study results announced in February showed in-home treatment with phototherapy was efficacious regardless of skin type.
“What we found, overwhelmingly, is that home phototherapy works just as well as office-based phototherapy, whether you have fair, medium or dark complected skin,” Gelfand said. “In general, home phototherapy patients did better in terms of skin being clear or almost clear, as well as for the patient reported endpoint of having no to minimal impact on health-related quality of life. That is an impressive finding for our patients.”
New form of research
Gelfand, who compared the effectiveness of phototherapy with that of many biologic and oral treatments for psoriasis, said the LITE study data represent a new form of research in dermatology: pragmatic, real-world research embedded in routine care, but with randomization to eliminate the forms of biases often seen in observational data. The LITE study was funded by the Patient Centered Outcomes Research Institute.
Home phototherapy uses the same narrow band 311 ultraviolet bulbs as in-office models, according to a National Psoriasis Foundation press release. These bulbs vary from commercial tanning beds, which use a different wavelength in the UVA spectrum, and are generally not recommended for treatment of psoriasis.
“These results are ready for prime time right now,” Gelfand told Healio. “I encourage my colleagues to consider the use of home phototherapy for patients with psoriasis when it is medically appropriate, based on your shared decision-making with your patient.”
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Gelfand JM, et al. S026 late-breaking research: session 1. Presented at: American Academy of Dermatology Annual Meeting; March 8-13, 2024; San Diego.
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