Home- vs Office-Based Narrowband UV-B Phototherapy for Patients With Psoriasis
Year: 2024
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Importance: Office-based phototherapy is cost-effective for psoriasis but difficult to access. Home-based phototherapy is patient preferred but has limited clinical data, particularly in patients with darker skin. Objective: To compare the effectiveness of home- vs office-based narrowband UV-B phototherapy for psoriasis. Design, Setting, and Participants: The Light Treatment Effectiveness study was an investigator-initiated, pragmatic, open-label, parallel-group, multicenter, noninferiority randomized clinical trial embedded in routine care at 42 academic and private clinical dermatology practices in the US. Enrollment occurred from March 1, 2019, to December 4, 2023, with follow-up through June 2024. Participants were 12 years and older with plaque or guttate psoriasis who were candidates for home- and office-based phototherapy. Interventions: Participants were randomized to receive a home narrowband UV-B machine with guided mode dosimetry or routine care with office-based narrowband UV-B for 12 weeks, followed by an additional 12-week observation period. Main Outcomes and Measures: The coprimary effectiveness outcomes were Physician Global Assessment (PGA) dichotomized as clear/almost clear skin (score of ≤1) at the end of the intervention period and Dermatology Life Quality Index (DLQI) score of 5 or lower (no to small effect on quality of life) at week 12. Results: Of 783 patients enrolled (mean [SD] age, 48.0 [15.5] years; 376 [48.0%] female), 393 received home-based phototherapy and 390 received office-based phototherapy, with 350 (44.7%) having skin phototype (SPT) I/II, 350 (44.7%) having SPT III/IV, and 83 (10.6%) having SPT V/VI. A total of 93 patients (11.9%) were receiving systemic treatment. At baseline, mean (SD) PGA was 2.7 (0.8) and DLQI was 12.2 (7.2). At week 12, 129 patients (32.8%) receiving home-based phototherapy and 100 patients (25.6%) receiving office-based phototherapy achieved clear/almost clear skin, and 206 (52.4%) and 131 (33.6%) achieved DLQI of 5 or lower, respectively. Home-based phototherapy was noninferior to office-based phototherapy for PGA and DLQI in the overall population and across all SPTs. Home-based phototherapy, compared to office-based phototherapy, was associated with better treatment adherence (202 patients [51.4%] vs 62 patients [15.9%]; P < .001), lower burden of indirect costs to patients, and more episodes of persistent erythema (466 of 7957 treatments [5.9%] vs 46 of 3934 treatments [1.2%]; P < .001). Both treatments were well tolerated with no discontinuations due to adverse events. Conclusions and Relevance: In this randomized clinical trial, home-based phototherapy was as effective as office-based phototherapy for plaque or guttate psoriasis in everyday clinical practice and had less burden to patients. Trial Registration: ClinicalTrials.gov Identifier: NCT03726489.
Source: JAMA Dermatology
Authors: Joel M. Gelfand, April W. Armstrong, Henry W. Lim, Steven R. Feldman, Sandra M. Johnson, W. C. Cole Claiborne, Robert E. Kalb, Jeannette Jakus, Aaron R. Mangold, R. Hal Flowers, Tina Bhutani, John R. Durkin, Jerry Bagel, Scott Fretzin, Michael P. Sheehan, James Krell, Margo Reeder, Jessica Kaffenberger, Francisca Kartono, Junko Takeshita, Alisha M. Bridges, Eric Fielding, Umbereen S. Nehal, Kenneth L. Schaecher, Leah M. Howard, Guy S. Eakin, Suzette Báez, Brooke E. Bishop, Robert C. Fitzsimmons, Maryte Papadopoulos, William B. Song, Kristin A. Linn, Rebecca A. Hubbard, Daniel B. Shin, Kristina Callis Duffin
Institutions: University of Pennsylvania, University of California, Los Angeles, Henry Ford Health, Henry Ford Hospital, Wake Forest University Health Sciences, Wake Forest University, University at Buffalo, State University of New York, SUNY Downstate Health Sciences University, Mayo Clinic, Mayo Clinic in Arizona, University of Virginia Health System, University of California, San Francisco, University of New Mexico, Icahn School of Medicine at Mount Sinai, Dawes Fretzin Clinical Research Group, Indiana University School of Medicine, University of Wisconsin–Madison, The Ohio State University Wexner Medical Center, The Ohio State University, Massachusetts Institute of Technology, University of Utah, National Psoriasis Foundation, Brown University
Language: English
Subfield: Immunology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W4402847595