Comparison of Narrowband UV-B With Psoralen–UV-A Phototherapy for Patients With Early-Stage Mycosis Fungoides

Abstract

IMPORTANCE Phototherapy is one of the mainstays of treatment for early mycosis fungoides (MF). The most common modalities are psoralen-UV-A (PUVA) and narrowband UV-B (NBUVB). OBJECTIVE To compare the efficacy and adverse effects of PUVA vs NBUVB in early-stage MF. DATA SOURCES A systematic review was performed by searching Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Ovid Medline, PubMed, Cochrane Library, American College of Physicians ACP Journal Club, and Database of Abstracts of Review of Effectiveness from inception to March 30, 2018. UV A, PUVA, mycosis fungoides, Sézary syndrome, cutaneous T-cell lymphoma, UV B, and UVB were used as either key words or MeSH terms. STUDY SELECTION Studies of cohorts with histologically confirmed early-stage MF, defined as stages IA, IB, and IIA, that compared PUVA vs NBUVB, had at least 10 patients in each comparator group, and reported outcomes of response to therapy. Exclusion criteria were studies with patients with stage IIB or higher MF, pediatric patients, fewer than 10 in each comparator group, noncomparative studies, case reports, and abstract studies. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Data were pooled using a random-effects model with odds ratio (OR) as effect size. MAIN OUTCOMES AND MEASURES Main outcomes were complete response rate, partial response rate, disease recurrence, and adverse effects, including erythema, nausea, pruritus, phototoxic effects, dyspepsia, and pain. RESULTS Seven studies were included with a total of 778 patients (405 of 724 [55.9%] men; mean age, 52 years); 527 were treated with PUVA and 251 with NBUVB. Most of the included studies were of poor to moderate quality. Any response was found in 479 of the 527 (90.9%) patients treated with PUVA vs 220 of 251 (87.6%) treated with NBUVB (OR, 1.40; 95% CI, 0.84-2.34; P = .20). Complete response was found in 389 of 527 (73.8%) patients who received PUVA vs 156 of 251 (62.2%) who received NBUVB, which was statistically significant (OR, 1.68; 95% CI, 1.02-2.76; P = .04). Partial response was similar (90 of 501 [18.0%] vs 64 of 233 [27.5%]; OR, 0.58; 95% CI, 0.33-1.04; P = .07). No significant difference was found between PUVA and NBUVB in terms of adverse effects of erythema (38 of 527 [7.2%] vs 17 of 251 [6.7%]; P = .54), nausea (10 of 527 [1.9%] vs 3 of 251 [1.2%]; P = .72), pruritus (2 of 527 [0.4%] vs 4 of 251 [1.7%]; P = .26), phototoxic effects (7 of 527 [1.4%] vs 2 of 251 [0.9%]; P = .72), dyspepsia (6 of 527 [1.2%] vs 0 of 251 [0%]; P = .59), or pain (0 of 527 [0%] vs 2 of 251 [0.9%]; P = .50). CONCLUSIONS AND RELEVANCE The findings suggest that PUVA is a potential alternative to NBUVB in the management of early-stage MF. These findings have implications for clinicians involved in the management of early-stage MF.

Is there still a role for UV therapy in itch treatment?

“…In cutaneous T‐cell lymphomas, such as MF or SS, photo(chemo)therapy is still an important treatment in early stages with predominant skin involvement . While NB‐UVB is similarly effective in early patch‐type MF, PUVA therapy is the phototherapeutic modality of choice in MF with more widespread patches or infiltrated plaques, as well as in SS …”

Quality of Life, Anxiety, and Depression in Patients With Early-Stage Mycosis Fungoides and the Effect of Oral Psoralen Plus UV-A (PUVA) Photochemotherapy on it

“…Furthermore, a recent meta-analysis reveals that complete Abbreviations: MF, mycosis fungoides; PUVA, psoralen plus UV-A; DLQI, Dermatology Life Quality Index; HADS, Hospital Anxiety and Depression Scale; QoL, quality of life; EORTC, The European Organisation for Research and Treatment of Cancer. response rates of PUVA being 73.8% in early stage MF (Ia-IIa) were significantly superior to that of UVB with 62.2% (24). Moreover, PUVA is considered to be the most helpful treatment option in early stage MF from the patients' perspective (1) although systemic treatments have recently been questioned to improve QoL (25).…”

“…However, in terms of efficacy, PUVA with its complete response rate of 70% in this study population ( 20 ) beats, by far, other treatment options, such as bexarotene (complete response rates 7–13%) ( 21 , 22 ) or interferon α-2a plus acitretin (complete response rate 38%) ( 23 ). Furthermore, a recent meta-analysis reveals that complete response rates of PUVA being 73.8% in early stage MF (Ia-IIa) were significantly superior to that of UVB with 62.2% ( 24 ). Moreover, PUVA is considered to be the most helpful treatment option in early stage MF from the patients' perspective ( 1 ) although systemic treatments have recently been questioned to improve QoL ( 25 ).…”

Phototherapy of mycosis fungoides

“…Согласно опубликованным результатам ретроспективного исследования V. Nikolaou и соавт., в которое вошли данные 227 пациентов с грибовидном микозом на ранних стадиях, уровень достижения полной ремиссии у больных, получающих ПУВА-терапию, был выше на 25 % по сравнению с таковым у больных после УФВ-311 нм (74,5 % против 55,9 % соответственно) [50]. В январе 2019 г. в журнале JAMA Dermatology были опубликованы результаты крупного ретроспективного исследования сравнительной эффективности УФВ-311 нм и ПУВА-терапии у больных грибовидным микозом на стадиях IA-IIA [51]. Авторы выполнили метаанализ данных 778 больных из 7 ранее проведенных ретроспективных исследований, при выборе пациентов учитывалась стадия заболевания (IA-IIA), а также в целях объективизации результатов отбирались пациенты со схожими режимами назначения УФВ-311 нм и ПУВА-терапии (табл.…”

“…Таким образом, метаанализ данных 7 ретроспективных исследований эффективности ПУВА-терапии и УФВ-311 нм в лечении больных грибовидным микозом с ранними стадиями показал, что частота общего ответа в обеих группах лечения была почти одинакова, однако применение ПУВА-терапии чаще приводит к достижению полных ремиссий, а случаи неэффективности регистрировались реже по сравнению с группой лечения УФВ-311 нм [51].…”