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American Journal of Clinical Dermatology
Erschienen in: American Journal of Clinical Dermatology 2/2013

01.04.2013 | Evidence-Based Review Article

Systematic Review of UV-Based Therapy for Psoriasis

verfasst von: Fahad Almutawa, Naif Alnomair, Yun Wang, Iltefat Hamzavi, Henry W. Lim

Erschienen in: American Journal of Clinical Dermatology | Ausgabe 2/2013

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Abstract

Background

UV-based therapies, which include narrow-band (NB) UVB, broad-band (BB) UVB, and psoralen and UVA (PUVA), are well known treatment options for moderate to severe plaque psoriasis. However, there are limited evidence-based reviews on their efficacy, short-term safety, and tolerability.

Aim

The aim of the study was to evaluate the efficacy, short-term safety, and tolerability of UV-based therapy in the treatment of adults with moderate to severe plaque psoriasis.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating NB-UVB, BB-UVB, and PUVA in adults with moderate to severe plaque-type psoriasis. Our efficacy outcomes were ≥ Psoriasis Area and Severity Index (PASI)-75 and clearance. We evaluated the short-term safety and tolerability from the percentage of adverse effects and withdrawal due to adverse effects, respectively.

Results

Forty-one RCTs, with a total of 2,416 patients, met the eligibility criteria and were included in the analysis. In regard to PASI-75 in monotherapy trials, PUVA (mean: 73 %, 95 % CI 56–88) was the most effective modality. Trials with BB-UVB also showed a high PASI-75 (73 %) but with a wide CI (18–98) due to heterogeneity of the total available three studies. This was followed by NB-UVB (mean: 62 %, 95 % CI 45–79) then bath PUVA (mean: 47 %, 95 % CI 30–65). In regard to clearance in the monotherapy trials, PUVA (mean: 79 %, 95 % CI 69–88) was superior to NB-UVB (mean: 68 %, 95 % CI 57–78), BB-UVB (mean: 59 %, 95 % CI 44–72), and bath PUVA (mean: 58 %, 95 % CI 44–72). The percentages of asymptomatic erythema development in monotherapy trials were 64 % for BB-UVB, 57 % for NB-UVB, 45 % for PUVA, and 34 % for bath PUVA. Symptomatic erythema or blistering percentages for the monotherapy trials were as follows: 7.8 % for NB-UVB, 2 % for BB-UVB, 17 % for PUVA, and 21 % for bath PUVA. The percentages of withdrawal due to adverse effects were 2 % for NB-UVB, 4.6 % for BB-UVB, 5 % for PUVA, and 0.7 % for bath PUVA monotherapy trials.

Conclusions

As a monotherapy, PUVA was more effective than NB-UVB, and NB-UVB was more effective than BB-UVB and bath PUVA in the treatment of adults with moderate to severe plaque-type psoriasis, based on clearance as an end point. Based on PASI-75, the results were similar except for BB-UVB, which showed a high mean PASI-75 (73 %) that was similar to PUVA, but with a wide CI (18–98). The short-term adverse effects were mild as shown by the low rate of withdrawal due to adverse effects.
Literatur
1.
Kirke SM, Lowder S, Lloyd JJ, et al. A randomized comparison of selective broadband UVB and narrowband UVB in the treatment of psoriasis. J Investig Dermatol. 2007;127:1641–6.PubMed
2.
Ramsay CA, Schwartz BE, Lowson D, et al. Calcipotriol cream combined with twice weekly broad-band UVB phototherapy: a safe, effective and UVB-sparing antipsoriatric combination treatment. The Canadian Calcipotriol and UVB Study Group. Dermatology. 2000;200:17–24.PubMedCrossRef
3.
Kurd SK, Gelfand JM. The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003–2004. J Am Acad Dermatol. 2009;60:218–24.PubMedCrossRef
4.
Rapp SR, Feldman SR, Exum ML, et al. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999;41:401–7.PubMedCrossRef
5.
Love TJ, Qureshi AA, Karlson EW, et al. Prevalence of the metabolic syndrome in psoriasis: results from the National Health and Nutrition Examination Survey, 2003–2006. Arch Dermatol. 2011;147:419–24.PubMedCrossRef
6.
Langan SM, Seminara NM, Shin DB, et al. Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United kingdom. J Invest Dermatol. 2012;132:556–62.PubMedCrossRef
7.
Griffiths CE, Christophers E, Barker JN, et al. A classification of psoriasis vulgaris according to phenotype. Br J Dermatol. 2007;156:258–62.PubMedCrossRef
8.
Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Sect. 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol. 2010;62:114–35.PubMedCrossRef
9.
Leon A, Nguyen A, Letsinger J, et al. An attempt to formulate an evidence-based strategy in the management of moderate-to-severe psoriasis: a review of the efficacy and safety of biologics and prebiologic options. Expert Opin Pharmacother. 2007;8:617–32.PubMedCrossRef
10.
Puzenat E, Bronsard V, Prey S, et al. What are the best outcome measures for assessing plaque psoriasis severity? A systematic review of the literature. J Eur Acad Dermatol Venereol. 2010;24(Suppl. 2):10–6.PubMedCrossRef
11.
Bansback N, Sizto S, Sun H, et al. Efficacy of systemic treatments for moderate to severe plaque psoriasis: systematic review and meta-analysis. Dermatology. 2009;219:209–18.PubMedCrossRef
12.
Blasco AJ, Lazaro P, Ferrandiz C, et al. Efficiency of biologic agents in the treatment of moderate to severe psoriasis [in Spanish]. Actas Dermosifiliogr. 2009;100:792–803.PubMedCrossRef
13.
Schmitt J, Zhang Z, Wozel G, et al. Efficacy and tolerability of biologic and nonbiologic systemic treatments for moderate-to-severe psoriasis: meta-analysis of randomized controlled trials. Br J Dermatol. 2008;159:513–26.PubMedCrossRef
14.
Zhang Z, Schmitt J, Wozel G, et al. Treatment of plaque psoriasis with biologics. a meta-analysis of randomized controlled trials (in German). Med Klin (Munich). 2009;104:125–36.PubMedCrossRef
15.
Fredriksson T, Pettersson U. Severe psoriasis: oral therapy with a new retinoid. Dermatologica. 1978;157:238–44.PubMedCrossRef
16.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.PubMedCrossRef
17.
Stuart A, Ord K. Kendall’s advanced theory of statistics. 6th ed. London: Edward Arnold; 1994.
18.
Miller J. The inverse of the Freemen-Tukey double arcsine transformation. Am Stat. 1978;32:138.
19.
Asawanonda P, Nateetongrungsak Y. Methotrexate plus narrowband UVB phototherapy versus narrowband UVB phototherapy alone in the treatment of plaque-type psoriasis: a randomized, placebo-controlled study. J Am Acad Dermatol. 2006;54:1013–8.PubMedCrossRef
20.
Behrens S, Grundmann-Kollmann M, Schiener R, et al. Combination phototherapy of psoriasis with narrow-band UVB irradiation and topical tazarotene gel. J Am Acad Dermatol. 2000;42:493–5.PubMedCrossRef
21.
Brands S, Brakman M, Bos JD, et al. No additional effect of calcipotriol ointment on low-dose narrow-band UVB phototherapy in psoriasis. J Am Acad Dermatol. 1999;41:991–5.PubMedCrossRef
22.
Chauhan PS, Kaur I, Dogra S, et al. Narrowband ultraviolet B versus psoralen plus ultraviolet A therapy for severe plaque psoriasis: an Indian perspective. Clin Exp Dermatol. 2011;36:169–73.PubMedCrossRef
23.
Dayal S, Mayanka, Jain V. Comparative evaluation of NBUVB phototherapy and PUVA photochemotherapy in chronic plaque psoriasis. Indian J Dermatol Venereol Leprol. 2010;76:533–7.PubMedCrossRef
24.
Kleinpenning MM, Smits T, Boezeman J, et al. Narrowband ultraviolet B therapy in psoriasis: randomized double-blind comparison of high-dose and low-dose irradiation regimens. Br J Dermatol. 2009;161:1351–6.PubMedCrossRef
25.
Mahajan R, Kaur I, Kanwar AJ. Methotrexate/narrowband UVB phototherapy combination vs. narrowband UVB phototherapy in the treatment of chronic plaque-type psoriasis: a randomized single-blinded placebo-controlled study. J Eur Acad Dermatol Venereol. 2010;24:595–600.PubMedCrossRef
26.
Snellman E, Klimenko T, Rantanen T. Randomized half-side comparison of narrowband UVB and trimethylpsoralen bath plus UVA treatments for psoriasis. Acta Derm Venereol. 2004;84:132–7.PubMedCrossRef
27.
Yones SS, Palmer RA, Garibaldinos TT, et al. Randomized double-blind trial of the treatment of chronic plaque psoriasis: efficacy of psoralen-UV-A therapy vs narrowband UV-B therapy. Arch Dermatol. 2006;142:836–42.PubMedCrossRef
28.
Legat FJ, Hofer A, Wackernagel A, Salmhofer W, Quehenberger F, Kerl H, et al. Narrowband UV-B phototherapy, alefacept, and clearance of psoriasis. Arch Dermatol. 2007;143:1016–22.PubMedCrossRef
29.
Ortonne JP, Khemis A, Koo JY, et al. An open-label study of alefacept plus ultraviolet B light as combination therapy for chronic plaque psoriasis. J Eur Acad Dermatol Venereol. 2005;19:556–63.PubMedCrossRef
30.
Ozdemir M, Engin B, Baysal I, et al. A randomized comparison of acitretin-narrow-band TL-01 phototherapy and acitretin-psoralen plus ultraviolet A for psoriasis. Acta Derm Venereol. 2008;88:589–93.PubMed
31.
Wolf P, Hofer A, Weger W, et al. 311 nm ultraviolet B-accelerated response of psoriatic lesions in adalimumab-treated patients. Photodermatol Photoimmunol Photomed. 2011;27:186–9.PubMedCrossRef
32.
Bagel J. LCD plus NB-UVB reduces time to improvement of psoriasis vs. NB-UVB alone. J Drugs Dermatol. 2009;8:351–7.PubMed
33.
Cameron H, Dawe RS, Yule S, et al. A randomized, observer-blinded trial of twice vs. three times weekly narrowband ultraviolet B phototherapy for chronic plaque psoriasis. Br J Dermatol. 2002;147:973–8.PubMedCrossRef
34.
Dawe RS, Cameron H, Yule S, et al. A randomized controlled trial of narrowband ultraviolet B vs bath-psoralen plus ultraviolet A photochemotherapy for psoriasis. Br J Dermatol. 2003;148:1194–204.PubMedCrossRef
35.
Dawe RS, Wainwright NJ, Cameron H, et al. Narrow-band (TL-01) ultraviolet B phototherapy for chronic plaque psoriasis: three times or five times weekly treatment? Br J Dermatol. 1998;138:833–9.PubMedCrossRef
36.
Gordon PM, Diffey BL, Matthews JN, et al. A randomized comparison of narrow-band TL-01 phototherapy and PUVA photochemotherapy for psoriasis. J Am Acad Dermatol. 1999;41:728–32.PubMedCrossRef
37.
Markham T, Rogers S, Collins P. Narrowband UV-B (TL-01) phototherapy vs oral 8-methoxypsoralen psoralen-UV-A for the treatment of chronic plaque psoriasis. Arch Dermatol. 2003;139:325–8.PubMedCrossRef
38.
Rim JH, Choe YB, Youn JI. Positive effect of using calcipotriol ointment with narrow-band ultraviolet B phototherapy in psoriatic patients. Photodermatol Photoimmunol Photomed. 2002;18:131–4.PubMedCrossRef
39.
de Berker DA, Sakuntabhai A, Diffey BL, et al. Comparison of psoralen-UVB and psoralen-UVA photochemotherapy in the treatment of psoriasis. J Am Acad Dermatol. 1997;36:577–81.PubMedCrossRef
40.
Khurshid K, Haroon TS, Hussain I. Psoralen-ultraviolet A therapy vs. psoralen-ultraviolet B therapy in the treatment of plaque-type psoriasis: our experience with Fitzpatrick skin type IV. Int J Dermatol. 2000;39:865–7.PubMedCrossRef
41.
Calzavara-Pinton P. Narrow band UVB (311 nm) phototherapy and PUVA photochemotherapy: a combination. J Am Acad Dermatol. 1998;38:687–90.PubMedCrossRef
42.
Brockow T, Schiener R, Franke A, et al. A pragmatic randomized controlled trial on the effectiveness of low concentrated saline spa water baths followed by ultraviolet B (UVB) compared to UVB only in moderate to severe psoriasis. J Eur Acad Dermatol Venereol. 2007;21:1027–37.PubMedCrossRef
43.
Valkova S. UVB phototherapeutic modalities: comparison of two treatments for chronic plaque psoriasis. Acta Dermatovenerol Alp Panonica Adriat. 2007;16:26–30.PubMed
44.
Dover JS, McEvoy MT, Rosen CF, et al. Are topical corticosteroids useful in phototherapy for psoriasis? J Am Acad Dermatol. 1989;20:748–54.PubMedCrossRef
45.
Menkes A, Stern RS, Arndt KA. Psoriasis treatment with suberythemogenic ultraviolet B radiation and a coal tar extract. J Am Acad Dermatol. 1985;12:21–5.PubMedCrossRef
46.
Kragballe K. Combination of topical calcipotriol (MC 903) and UVB radiation for psoriasis vulgaris. Dermatologica. 1990;181:211–4.PubMedCrossRef
47.
Molin L, Liberton H, Van Weelden H, et al. Topical calcipotriol combined with phototherapy for psoriasis: the results of two randomized trials and a review of the literature. Dermatology. 1999;198:375–81.PubMedCrossRef
48.
Collins P, Rogers S. Bath-water compared with oral delivery of 8-methoxypsoralen PUVA therapy for chronic plaque psoriasis. Br J Dermatol. 1992;127:392–5.PubMedCrossRef
49.
El-Mofty M, El Weshahy H, Youssef R, et al. A comparative study of different treatment frequencies of psoralen and ultraviolet A in psoriatic patients with darker skin types (randomized-controlled study). Photodermatol Photoimmunol Photomed. 2008;24:38–42.PubMedCrossRef
50.
Lauharanta J, Juvakoski T, Lassus A. A clinical evaluation of the effects of an aromatic retinoid (Tigason), combination of retinoid and PUVA, and PUVA alone in severe psoriasis. Br J Dermatol. 1981;104:325–32.PubMedCrossRef
51.
Sivanesan SP, Gattu S, Hong J, et al. Randomized, double-blind, placebo-controlled evaluation of the efficacy of oral psoralen plus ultraviolet A for the treatment of plaque-type psoriasis using the Psoriasis Area Severity Index score (improvement of 75% or greater) at 12 weeks. J Am Acad Dermatol. 2009;61:793–8.PubMedCrossRef
52.
Torras H, Aliaga A, Lopez-Estebaranz JL, et al. A combination therapy of calcipotriol cream and PUVA reduces the UVA dose and improves the response of psoriasis vulgaris. J Dermatolog Treat. 2004;15:98–103.PubMedCrossRef
53.
Collins P, Wainwright NJ, Amorim I, et al. 8-MOP PUVA for psoriasis: a comparison of a minimal phototoxic dose-based regimen with a skin-type approach. Br J Dermatol. 1996;135:248–54.PubMedCrossRef
54.
Kirby B, Buckley DA, Rogers S. Large increments in psoralen-ultraviolet A (PUVA) therapy are unsuitable for fair-skinned individuals with psoriasis. Br J Dermatol. 1999;140:661–6.PubMedCrossRef
55.
Saurat JH, Geiger JM, Amblard P, et al. Randomized double-blind multicenter study comparing acitretin-PUVA, etretinate-PUVA and placebo-PUVA in the treatment of severe psoriasis. Dermatologica. 1988;177:218–24.PubMedCrossRef
56.
Vongthongsri R, Konschitzky R, Seeber A, et al. Randomized, double-blind comparison of 1 versus 5 mg/L methoxsalen bath-PUVA therapy for chronic plaque-type psoriasis. J Am Acad Dermatol. 2006;55:627–31.PubMedCrossRef
57.
Lauharanta J, Geiger JM. A double-blind comparison of acitretin and etretinate in combination with bath PUVA in the treatment of extensive psoriasis. Br J Dermatol. 1989;121:107–12.PubMedCrossRef
58.
Ibbotson SH, Bilsland D, Cox NH, et al. An update and guidance on narrowband ultraviolet B phototherapy: a British Photodermatology Group Workshop Report. Br J Dermatol. 2004;151:283–97.PubMedCrossRef
59.
Dawe RS. A quantitative review of studies comparing the efficacy of narrow-band and broad-band ultraviolet B for psoriasis. Br J Dermatol. 2003;149:669–72.PubMedCrossRef
60.
Ashcroft DM, Li Wan Po A, Williams HC, et al. Combination regimens of topical calcipotriene in chronic plaque psoriasis: systematic review of efficacy and tolerability. Arch Dermatol. 2000;136:1536–43.PubMedCrossRef
61.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–87.PubMedCrossRef
Metadaten
Titel
Systematic Review of UV-Based Therapy for Psoriasis
verfasst von
Fahad Almutawa
Naif Alnomair
Yun Wang
Iltefat Hamzavi
Henry W. Lim
Publikationsdatum
01.04.2013
Verlag
Springer International Publishing AG
Erschienen in
American Journal of Clinical Dermatology / Ausgabe 2/2013
Print ISSN: 1175-0561
Elektronische ISSN: 1179-1888
DOI
https://doi.org/10.1007/s40257-013-0015-y

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