Adjuvant Ultraviolet-Based Therapy More Effective vs Monotherapy in Psoriasis

The efficacy of ultraviolet (UV)-based phototherapy for psoriasis may be improved when combined with other adjuvant therapies, according to study findings published last week in Annals of Medicine.

Beyond the use of systemic therapies such as oral retinoids or biologics, UV-based phototherapy with UVB or psoralen UVA (PUVA) has been shown to be a well-established and generally effective therapeutic option for the treatment of psoriasis. Moreover, researchers said that although systemic and biological treatments are strongly recommended for severe and diffuse skin diseases, these medications can cause systemic adverse effects and immunosuppression.

“These UV-based phototherapies, along with their combination with other treatments, are thought to be effective treatments for many patients with psoriasis, leading to an urgent demand for comparative studies of efficacy referring to clinical decision-making,” they noted.

Seeking to compare the clinical efficacy and safety profile of different UV-based phototherapies in the treatment of psoriasis, the investigators conducted a meta-analysis of randomized controlled trials registered in the PubMed, Cochrane Library, Scopus, and Embase databases.

UV-based therapies were assessed as a monotherapy or in combination with various drugs and remedies, including systematic treatments, skin lubricants, vitamins, and vitamin derivatives in the treatment of moderate to severe psoriasis. Five phototherapy strategies were identified and analyzed:

• PUVA
• UVB
• Combined adjuvant therapy with PUVA (cPUVA)
• Combined adjuvant therapy with UVB (cUVB)
• The combination of PUVA with UVB
  

The primary outcome for assessing effectiveness and safety was Psoriasis Area and Severity Index (PASI) 75 response (75% or more reduction in PASI score from baseline) and withdrawal due to adverse events, in which effects were ranked and calculated by surface under the cumulative ranking analysis (SUCRA).

In the meta-analysis, 32 studies involving 2120 patients with psoriasis (mean age, 41.5 years; 61.6% male) were included. Compared with monotherapy of PUVA and UVB, PASI 75 response was significantly higher in those treated with cPUVA (risk ratio [RR], 1.39; 95% CI, 1.00-1.94) and cUVB (RR, 1.27; 95% CI, 1.03-1.57), respectively. Moreover, PUVA combined with vitamin D and its derivatives ranked highest concerning clinical effect and safety (clusterank value = 7393.2).

Regarding safety, no significant difference was reported for withdrawal due to adverse events or incidence of erythema. The relatively safest strategy was cPUVA, particularly PUVA combined with calcium/vitamin D derivatives (RR, 0.98; 95% CI, 0.30-3.17; SUCRA = 80.8%).

“cPUVA and cUVB, especially combined with calcium/vitamin D derivatives, are both safe and effective treatments for psoriasis and have the potential for the first choice in the treatment of moderate to severe psoriasis,” concluded the researchers. “However, more high-quality trials are necessary for confirming our findings.”

Reference

Li Y, Cao Z, Guo J, et al. Assessment of efficacy and safety of UV-based therapy for psoriasis: a network meta-analysis of randomized controlled trials. Ann Med. Published online January 6, 2022. doi:10.1080/07853890.2021.2022187