Efficiency of Acitretin in Combination With UV-B in the Treatment of Severe Psoriasis

Abstract

Compared with the antipsoriatic retinoid etretinate, the new aromatic retinoid acitretin represents an important advance due to its rapid elimination kinetics. Since in psoriasis vulgaris retinoids are used predominantly in combination regimens, we investigated the therapeutic efficacy of acitretin and UV-B compared with placebo and UV-B in a double-blind, randomized multicenter trial in 82 patients with severe psoriasis. They were treated with 35 mg of the study medication during the first 4 weeks of therapy and 25 mg thereafter, concomitantly with UV-B irradiation in increasing energy doses. Forty patients who underwent therapy with acitretin and UV-B and 38 patients who underwent therapy with placebo and UV-B were evaluated for efficacy. The target variables--psoriasis severity index and total UV-B dose--were reported at intervals of 2 weeks over a maximum period of 8 weeks. At the end of treatment, the psoriasis severity index decrease was 79% in the acitretin and UV-B group and 35% in the placebo and UV-B group. The response rate, defined as greater than or equal to a 75% decrease of the psoriasis severity index, was 60% for the combination treatment and only 24% for the control treatment. This treatment response was achieved with markedly lower cumulative UV-B energy. The median cumulative UV-B energy applied to reach 75% clinical improvement was 11.8 J/cm2 vs 6.9 J/cm2. Side effects showed a similar pattern in both groups. Our data show that the acitretin dramatically improves the results of UV-B treatment in patients with severe psoriasis. In addition, it markedly decreases the effective cumulative UV-B dose, thereby reducing the potential long-term hazards of UV irradiation. We conclude that the acitretin plus UV-B combination treatment represents a highly effective therapeutic regimen in severe psoriasis.

Phototherapy and Photochemotherapy for Psoriasis

“…42,43 NB-UV-B plus retinoid and PUVA plus retinoid therapies were shown to have similar effects in terms of clearance rate in chronic plaque and guttate psoriasis, as shown by two RCTs reviewed in a recent Cochrane review. 12 Combination of phototherapy with methotrexate has been shown to increase the efficacy of NB-UV-B treatment.…”

A Delphi Consensus Approach to Challenging Case Scenarios in Moderate-to-Severe Psoriasis: Part 2

“…Acitretin and UVB therapy have greater efficacy than UVB therapy alone (grade A evidence) [6]. The acitretin and PUVA combination also has a higher clearance rate than PUVA alone and has the additional benefit of reducing the total PUVA exposure by 42% (grade A evidence) [7].…”

A single-blind study comparing acitretin and narrow-band UVB with the combination of placebo and narrow-band UVB in the treatment of plaque-type psoriasis

“…Sekiz haftalık tedavi sonrasında asitretin ve dar bant UVB tedavisi alan grupta ortalama PAŞİ skorunda %79 iyileşme izlenmiştir. Diğer grupta ise ortalama PAŞİ skorunda %35 iyileşme sağlanabilmiştir 19 . Iest ve ark.…”