A randomized comparison of narrow-band TL-01 phototherapy and PUVA photochemotherapy for psoriasis

doi:10.1016/S0190-9622(99)70008-3

Journal of the American Academy of Dermatology

Volume 41, Issue 5, November 1999, Pages 728-732

https://doi.org/10.1016/S0190-9622(99)70008-3 Get rights and content

Abstract

Background: Although PUVA treatment of psoriasis is more effective than conventional or broad-band UVB phototherapy, two small studies have suggested that narrow-band or TL-01 phototherapy may have a therapeutic effect equal to PUVA. If confirmed, this would be of considerable importance as TL-01 therapy is likely to be considerably safer in the long term than PUVA. Objective: The purpose of this study was to compare PUVA with narrow-band (TL-01) phototherapy in psoriasis. Methods: We studied 100 patients with plaque-type psoriasis who were randomly allocated to twice-weekly treatment with PUVA or narrow-band UVB. Results: Clearance of psoriasis was achieved in a significantly greater proportion of patients treated with PUVA (84%) than with TL-01 (63%) (P = .018), and with significantly fewer treatments (median number of treatments for clearance with PUVA, 16.7; with TL-01, 25.3; P = .001). Only 12% of those treated with TL-01 were clear of psoriasis 6 months after finishing treatment compared with 35% for PUVA (P = .002). Conclusion: When given twice weekly, PUVA is more effective for psoriasis than narrow-band UVB phototherapy. (J Am Acad Dermatol 1999;41:728-32.)

Section snippets

Patients

The design of the trial was similar to that used in a previous comparison of PUVA and psoralen-UVB treatment.¹¹ We studied 100 adults with chronic plaque-type psoriasis of moderate to severe extent, referred by other dermatologists for treatment to a dedicated “PUVA” clinic. Recruitment took place during a 14-month period from July 1996 to September 1997. Sample size estimation, as reported previously,¹¹ suggested that for 80% power to detect a decrease in median exposure of 25% at the 5%

RESULTS

Of the 100 patients studied, 51 were allocated to receive TL-01 and 49 to receive PUVA. The two groups were well matched with regard to skin type, plaque size (Table I) and age; mean age (standard deviation) for the TL-01 group was 43.3 (12.9) years and 41.0 (11.2) years for the PUVA group.

. Allocation of treatment, TL-01 or PUVA, according to skin type and predominant plaque size (>3 cm, <3 cm)

Empty Cell	I	II	III	IV	Total
Empty Cell	Skin type
Small-plaque psoriasis
TL-01	2	14	13	0	29
PUVA	6	10	8	4	28
Large-plaque psoriasis
TL-01	3	7	11	1	22

DISCUSSION

This trial has shown important differences in the response of patients with plaque-type psoriasis to PUVA and TL-01 therapy. The method of treatment allocation ensured that the two groups were well matched, and the design of the trial, with pretreatment phototesting, ensured that both treatments were given as efficiently as possible.20, 21 Because of the steeper dose-response curve for UVB-induced erythema,²² to maintain an equal erythema dose, smaller percentage dose increments were used for

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Therapeutic wavelengths of ultraviolet B radiation activate apoptotic, circadian rhythm, redox signalling and key canonical pathways in psoriatic epidermis
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Ultraviolet B radiation (UVB) exerts pleiotropic effects on human skin. DNA damage response and repair pathways are activated by UVB; if damage cannot be repaired, apoptosis ensues. Although cumulative UVB exposure predisposes to skin cancer, UVB phototherapy is widely used as an effective treatment for psoriasis. Previous studies defined the therapeutic action spectrum of UVB and showed that psoriasis is resistant to apoptosis. This study aimed to investigate early molecular responses within psoriasis plaques following irradiation with single equi-erythemogenic doses of clinically-effective (311 nm, narrow-band) compared to clinically-ineffective (290 nm) UVB. Forty-eight micro-dissected epidermal samples from 20 psoriatic patients were analyzed using microarrays. Our bioinformatic analysis compared gene expression between 311 nm irradiated, 290 nm irradiated and control psoriasis epidermis to specifically identify 311 nm UVB differentially expressed genes (DEGs) and their upstream regulatory pathways. Key DEGs and pathways were validated by immunohistochemical analysis.
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^☆: Reprint requests: Peter M. Farr, MD, Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.

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A randomized comparison of narrow-band TL-01 phototherapy and PUVA photochemotherapy for psoriasis☆,☆☆

Abstract

Section snippets

Patients

RESULTS

DISCUSSION

Lancet

J Invest Dermatol

J Am Acad Dermatol

J Invest Dermatol

J Am Acad Dermatol

Photochemotherapy of skin disease

The carcinogenic risk of treatments for severe psoriasis

Cancer

Skin cancers or premalignant lesions occur in half of high-dose PUVA patients

Br J Dermatol

UV-light treatment of psoriasis

Acta Derm Venereol (Stockh)

Therapy of psoriasis: comparison of photochemotherapy and several variants of phototherapy

Br J Dermatol

Comparison of narrow-band UV-B phototherapy and PUVA photochemotherapy in the treatment of psoriasis

Acta Derm Venereol (Stockh)

Halfside comparison study on narrow-band UV-B phototherapy versus photochemotherapy (PUVA) in the treatment of severe psoriasis [abstract]

J Invest Dermatol

Long-term side effects and carcinogenic risk in UVB therapy

Response of psoriasis to twice weekly PUVA

Br J Dermatol