A Short Cycle of Narrow-Band UVB Phototherapy in the Early Phase of Dupilumab Therapy Can Provide a Quicker Improvement of Severe Atopic Dermatitis

Abstract

<b><i>Background:</i></b> Since the best clinical response to dupilumab is achieved after 12–16 weeks, a combination therapy at the beginning of the treatment could be a helpful strategy to reach a faster response in patients with severe atopic dermatitis (AD). <b><i>Objectives:</i></b> To quantify the benefit of a combination of dupilumab treatment with a short course of narrow-band ultraviolet B (NB-UVB) phototherapy. <b><i>Methods:</i></b> In the present pilot study adult patients suffering from severe AD were enrolled with a 2:1 ratio to receive treatment with dupilumab alone or dupilumab plus NB-UVB phototherapy, for 12 weeks. After the twelfth week, all patients received dupilumab only. A follow-up visit took place after 16 weeks. Both clinician-oriented and patient-oriented scores were assessed at baseline (T0) and after 4 (T1), 12 (T2) and 16 (T3) weeks. <b><i>Results:</i></b> Forty-five adult patients were enrolled in the study. Both treatment regimens were well tolerated and very effective on all measured scores (EASI, SCORAD, BSA, NRS of itching, NRS of sleep loss, DLQI, POEM and HADS), but the combined regimen led to a more robust clinical improvement of lesions and relief of symptoms after 4 weeks. However, after 12 and 16 weeks, the additional therapeutic effect of phototherapy weakened. <b><i>Conclusion:</i></b> NB-UVB phototherapy can provide a faster remission of severe AD in the first few weeks of dupilumab therapy.

NRF2 in dermatological disorders: Pharmacological activation for protection against cutaneous photodamage and photodermatosis

“…Lipsky and German have recently determined the mechanical properties of isolated SC under UVR exposure and found that both UVA and UVB radiation cause mechanical and structural degradation [ 23 ]. Regardless of these harmful effects, UVB radiation was shown to have positive compensatory effects on the epidermal barrier when administered in low doses and over a relatively short period [ 24 , 25 ]. This therapeutic strategy is being used for the treatment of skin diseases with a disrupted epidermal barrier, such as atopic dermatitis, avoiding the possible side effects by applying only reduced intensity and exposure.…”

Phototherapy: Theory and practice

“…However, after 12 and 16 weeks, the additional therapeutic effect of phototherapy diminished. 49 According to the current European guideline for the treatment of AD, children with moderate AD (SCORAD index can also be treated with narrowband UVB radiation. 50 The good efficacy of narrowband UVB therapy in children has been demonstrated in two clinical trials from India and England.…”

“…The combination therapy resulted in superior improvement in clinical lesions and symptom relief at 4 weeks. However, after 12 and 16 weeks, the additional therapeutic effect of phototherapy diminished 49 …”

Phototherapie in Theorie und Praxis

“…45 Laut der Leitlinie zur atopischen Dermatitis ist bei mittelschwerer atopischen Dermatitis UVA1 in mittlerer Dosierung ähnlich effektiv wie die Hochdosis UVA1 Strahlung. 46 49 Nach der aktuellen europäischen Leitlinie zur Behandlung der AD können auch Kinder mit moderater AD (SCORAD-Index 25-50) mit Schmalband UVB behandelt werden. 50 Die gute Wirksamkeit der Schmalband UVB Therapie bei Kindern konnte in zwei klinischen Studien aus Indien und England gezeigt werden.…”

“…Das kombinierte Schema führte zur stärkerer klinischer Verbesserung der Läsionen und Linderung der Symptome nach 4 Wochen. Nach 12 und 16 Wochen schwächte sich der zusätzliche therapeutische Effekt der Phototherapie jedoch ab 49 …”