Extended findings of LITE study solidify home-based phototherapy efficacy for psoriasis

Key takeaways:

• 32.8% of patients using home-based phototherapy achieved clear or almost clear skin vs. 25.6% of office-based users.
• Treatment adherence was much higher in the home vs. office-based group (51.4% vs. 15.9%).

Home-based phototherapy proved effective for the treatment of plaque and guttate psoriasis across skin types, providing a convenient therapy method for patients, according to a study.

Previously presented as a late-breaker at the American Academy of Dermatology Annual Meeting, results from the Light Treatment Effectiveness (LITE) study were recently published in JAMA Dermatology, confirming the usefulness of home-based phototherapy for the treatment of psoriasis.

“Phototherapy remains highly relevant to current dermatology practice,” 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, told Healio. “The LITE study found compelling evidence that home phototherapy is safe and highly effective for plaque and/or guttate psoriasis in routine clinical practice across all skin types.”

The LITE study included data on 783 (mean age, 48 years; 48% female; 75.1% white) individuals aged 12 years and older with plaque or guttate psoriasis. In the cohort, 44.7% of patients had skin types I or II, another 44.7% had skin types III or IV and the remaining 10.6% had skin types V or VI.

Patients were randomly assigned to receive home-based narrowband UVB phototherapy (n = 393) or office-based phototherapy (n = 390) for 12 weeks.

“LITE is unique in that it was embedded in routine care and the entry criteria were simple and reflect everyday clinical practice,” Gelfand explained. “Forty percent of patients in the LITE study previously used oral or biologics and 12% were currently using these treatments during the study.”

After 12 weeks, Gelfand and his colleagues found that home-based phototherapy was just as, if not more, effective as office-based phototherapy for the treatment of psoriasis with 32.8% and 25.6% achieving clear or almost clear skin.

More than half (52.4%) of patients receiving home-based phototherapy reported a DLQI of 5 or lower compared with 33.6% of those going into the office for the same treatment.

Home-based phototherapy was noninferior to office-based phototherapy across multiple secondary outcomes.

“Patients achieve excellent outcomes both at home and in the office,” Gelfand said, “but patients treated at home had better outcomes likely related to much better adherence to treatment.”

The study showed that treatment adherence was much higher in the home-based group vs. the office-based group (51.4% vs. 15.9%; P < .001).

Of note was the stark improvement among patients with skin types V and VI in this cohort. Along with around 32% to 34% of patients in other skin types groups who used home-based phototherapy, 33.3% of those with skin types V and VI achieved Physician Global Assessment (PGA) 0 or 1. While around 25% to 28% of patients in the other skin type groups achieved PGA 0 or 1 using office-based phototherapy, only 14.6% of patient with skin types V and VI achieved the same. Although enrollment in this group was lower than the other skin types, the researchers still called these “robust” results.

“It was possible that people with darkly pigmented skin may not do as well at home because home machines have many fewer bulbs than office machines and thus treatment times are longer for people of color. However, we actually found the opposite,” Gelfand said. “Patients of color did especially well with home phototherapy compared to office phototherapy. We think this study is a good example of how to a priori plan for enrolling a diverse patient population to be certain the results apply to all.”

The study also found that the burden of indirect costs to patients was much less among those who used home-based vs. office-based phototherapy. However, according to Gelfand, a limitation of this study includes the provision of the home-based phototherapy machines by Daavlin, as opposed to insurance.

“Coverage of home phototherapy is often highly variable and when insurance companies do cover it, they often still make it very difficult to prescribe it,” Gelfand told Healio. “We are currently working with several health insurance companies and health systems to implement the findings and make home phototherapy easier for dermatologists to prescribe and manage.”

Overall, home-based therapy was equally, if not more, effective in treating psoriasis, making it a promising option for patients, according to Gelfand.

“The size and scope of the study support home phototherapy being considered a first line treatment option for plaque and guttate psoriasis when a dermatology practitioner thinks it is medically appropriate,” Gelfand concluded.

For more information:

Joel M. Gelfand, MD, MSCE, can be reached at Joel.Gelfand@pennmedicine.upenn.edu.