Home Narrowband UV-B Phototherapy in Combination With Low-Dose Acitretin in Patients With Moderate to Severe Psoriasis

Yelverton, Christopher B.; Yentzer, Brad A.; Clark, Adele; Pearce, Daniel J.; Balkrishnan, Rajesh; Camacho, Fabian; Boles, Ann; Fleischer, Alan B.; Feldman, Steven R.

doi:10.1001/archderm.144.9.1224

Cited by 12 publications

(8 citation statements)

References 5 publications

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“…On the basis of this trial we cannot make any statements on the risk of non-prescribed irradiations in such settings. Recently, however, one study51 described another measure that also provides additional safety through preventing long term use and misuse. The study used home ultraviolet B light panels that were fitted with an electronic control to allow a preset number of irradiations.…”

Section: Discussionmentioning

confidence: 99%

“…The study used home ultraviolet B light panels that were fitted with an electronic control to allow a preset number of irradiations. When this number had been used the patients had to contact their dermatologist for a new code to obtain additional irradiations 51. Other ways to prevent non-prescribed use of home ultraviolet B light therefore exist and are being used.…”

Section: Discussionmentioning

confidence: 99%

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Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study)

Koek

Buskens

Weelden

et al. 2009

BMJ

109

111

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Objective To determine whether ultraviolet B phototherapy at home is equally safe and equally effective as ultraviolet B phototherapy in an outpatient setting for patients with psoriasis. Design Pragmatic multicentre single blind randomised clinical trial (PLUTO study). Setting Dermatology departments of 14 hospitals in the Netherlands. Participants 196 patients with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy. The first 105 consecutive patients were also followed for one year after therapy. Intervention Ultraviolet B phototherapy at home using a TL-01 home phototherapy unit compared with standard narrowband ultraviolet B phototherapy in an outpatient setting. Both therapies were done in a setting reflecting routine daily practice in the Netherlands. Main outcome measures The main outcome measure was effectiveness as measured by the proportion of patients with a 50% or more reduction of the baseline psoriasis area and severity index (PASI) or self administered psoriasis area and severity index (SAPASI), called the PASI 50 and SAPASI 50 (relevant treatment effect). Another outcome of effectiveness was the percentage reduction in median scores on the PASI as well as SAPASI. Also the proportions of patients reaching the PASI 75 and SAPASI 75 (successful treatment effect), and the PASI 90 and SAPASI 90 (almost complete clearance) were calculated. Other secondary outcomes were quality of life (SF-36, psoriasis disability index), burden of treatment (questionnaire), patients' preferences and satisfaction (questionnaire), and dosimetry and short term side effects (diary). Results 82% of the patients treated at home compared with 79% of the patients treated in an outpatient setting reached the SAPASI 50 (difference 2.8%, 95% confidence interval −8.6% to 14.2%), and 70% compared with 73% reached the PASI 50 (−2.3%, −15.7% to 11.1%). For patients treated at home the median SAPASI score decreased 82% (from 6.7 to 1.2) and the median PASI score decreased 74% (from 8.4 to 2.2), compared with 79% (from 7.0 to 1.4) and 70% (from 7.0 to 2.1) for patients treated in an outpatient setting. Treatment effect as defined by the mean decline in PASI and SAPASI scores was significant (P<0.001) and similar across groups (P>0.3). Total cumulative doses of ultraviolet B light were similar (51.5 v 46.1 J/cm 2 , difference 5.4, 95% confidence interval −5.2 to 16.0), and the occurrence of short term side effects did not differ.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study)

Koek

Buskens

Weelden

et al. 2009

BMJ

109

111

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“…Acitretin has also been used in combination with home NB-UVB phototherapy. 79,80 Acitretin in combination with UV therapy, despite the reduction of cumulative dosing, costs, and potential systemic toxicities, remains less used than expected given the potential benefits. 81 Combination UVB with PUVA Concomitant treatment with PUVA and UVB therapy may be associated with more rapid clearing than either therapy used alone.…”

Section: Uvb Combination Therapy Combination Uvb With Topical Therapiesmentioning

confidence: 99%

Guidelines of care for the management of psoriasis and psoriatic arthritis

Menter

Korman

Elmets

et al. 2010

Journal of the American Academy of Dermatology

Self Cite

316

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“…Home treatment sessions are performed at the convenience of the patient. Compliance, adherence and patient uptake of phototherapy as a treatment for psoriasis is also improved compared with conventional hospital‐based care . When patient training and supervision have been optimized, as for example in the Netherlands, studies have demonstrated no difference in the acute adverse events or total cumulative UV dose between outpatient‐based and home‐based phototherapy, suggesting that the safety profile of both are similar …”

Section: Methodsmentioning

confidence: 99%

“…Compliance, adherence and patient uptake of phototherapy as a treatment for psoriasis is also improved compared with conventional hospital-based care. 3,5 When patient training and supervision have been optimized, as for example in the Netherlands, studies have demonstrated no difference in the acute adverse events or total cumulative UV dose between outpatient-based and home-based phototherapy, suggesting that the safety profile of both are similar. 6,7 Cost-effectiveness Detailed and accurate health economic analysis was carried out in the PLUTO study, 8 and published the year after the initial RCT by Koek et al 3 The total costs for home phototherapy was slightly higher than for outpatient phototherapy but there was no difference in the health effects as measured in qualityadjusted life years.…”

Section: Advantages and Disadvantages Of Home Phototherapymentioning

confidence: 99%

Home phototherapy for psoriasis: a review and update

et al. 2015

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A 2006 survey of dermatologists showed that home phototherapy should be used with caution, and that general, nonevidence-based opinions were widespread about this form of therapy. This led to a randomized controlled trial to assess the safety and efficacy of home phototherapy vs. outpatient phototherapy by the same authors in 2009, which concluded that a lower burden of treatment and increased patient satisfaction were associated with home phototherapy. In the UK National Health Service, with a single exception, phototherapy is currently carried out exclusively in hospital. This contrasts with the Netherlands, where home phototherapy is now widely available. NHS dermatology services in the UK have yet to adopt home phototherapy as a treatment option, despite the strong evidence base and robust service models established elsewhere. In this review, we discuss evidence-based papers on home phototherapy, its advantages and disadvantages, economic effectiveness, and a suggested model for service sustainability.

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Home Narrowband UV-B Phototherapy in Combination With Low-Dose Acitretin in Patients With Moderate to Severe Psoriasis

Cited by 12 publications

References 5 publications

Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study)

Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study)

Guidelines of care for the management of psoriasis and psoriatic arthritis

Home phototherapy for psoriasis: a review and update

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