Home-Based UVB Phototherapy as Effective as Office-Based Phototherapy for Psoriasis

Joel M. Gelfand, MD/ Credit: Penn Medicine

Use of home-based phototherapy for patients with plaque or guttate psoriasis is as impactful as office-based phototherapy across all skin tones, new findings suggest, with the former leading to lower indirect costs among patients.¹

These data represented the conclusion of new research led by Joel M. Gelfand, MD, from the department of dermatology at the University of Pennsylvania, Philadelphia. Gelfand et al. noted that narrowband 311 nanometer UV-B phototherapy has been widely implemented in dermatology offices for a long time.²

The investigators added, however, that the data available on home-based phototherapy’s implementation among a diverse set of patients are limited. Consequently, they stated that this has contributed to a poor level of insurance coverage and uncertainty regarding the prescribing of this method of phototherapy.²

“To address this evidence gap, we conducted a randomized pragmatic trial of home- vs office-based phototherapy embedded in routine care of patients with psoriasis,” Gelfand and colleagues wrote.¹

Background and Design

The open-label, parallel-group study was embedded within routine clinical care during the course of the study. Recruitment of participants took place between March 2019 - December 2023, with later follow-up meetings continuing to occur through to June 2024.

The investigators’ Light Treatment Effectiveness (LITE) study was a multicenter, pragmatic, randomized clinical trial which they created to compare the 2 aforementioned methods of UVB phototherapy treatment. LITE was carried out within 42 academic and private dermatology practices found across the US.

Individuals in the age range of 12 years and older with plaque or guttate psoriasis were involved as subjects in the study. They were deemed as eligible provided they were candidates for either home-based or office-based phototherapy and did not meet any of the team’s exclusion criteria.

Random assignment of these participants to be given either a home narrowband UV-B machine along with guided mode dosimetry or standard office-based narrowband UV-B treatment took place, and they were treated with phototherapy over the course of 12 weeks. The research team followed up this treatment phase with an additional 12-week period of observation.

In terms of their outcomes, the team determined their coprimary effectiveness measures to have been a report of clear or almost clear skin. This would be assessed through the use of the Physician Global Assessment (PGA) at the conclusion of the aforementioned treatment period.

Additionally, the investigators evaluated patients’ successful achievement of a Dermatology Life Quality Index (DLQI) score of 5 or lower. This would suggest little to no impact on subjects’ quality of life, and the team assessed this at the 12-week mark.

Major Findings

Overall, there were a total of 783 subjects that the research team enrolled in their research, with the group having a mean age of 48.0 years and 48.0% being female. The team gave 393 of these subjects home-based phototherapy and gave 390 office-based phototherapy.

The investigators noted that 44.7% were shown to have skin phototype (SPT) I/II, 44.7% were shown to have SPT III/IV, and 10.6% were shown to have SPT V/VI. The research team added that systemic treatments were being received by 11.9%.

At the point of baseline, the team found that mean PGA scores had been 2.7 and DLQI had been 12.2. In their research’s conclusion, the investigators reported that home-based phototherapy had been noninferior to the office-based version for both PGA and DLQI in the general population and across each and every one of the SPTs.

Specifically, they found that 32.8% of those given access to home-based phototherapy and 25.6% of those accessing office-based phototherapy were successful in achieving clear/almost clear skin. The research team also found that 52.4% and 33.6% were successful in achieving DLQI of 5 or below, respectively.

In terms of treatment adherence, the home-based version was superior among 51.4% versus 15.9%, respectively (P < .001). The team also found that there was a lower burden of indirect costs to subjects, as well as additional periods of persistent erythema (466 of 7957 treatments [5.9%] compared to 46 of 3934 [1.2%]; P < .001). Additionally, they found no discontinuations had taken place due to any adverse events.

“Phototherapy delivered at home or in the office resulted in excellent outcomes for patients," they said. "Efforts should be made to make these safe, effective, and relatively inexpensive treatment options more available to patients in the modern era of psoriasis therapeutics.”

References

1. ^{Gelfand JM, Armstrong AW, Lim HW, et al. Home- vs Office-Based Narrowband UV-B Phototherapy for Patients With Psoriasis: The LITE Randomized Clinical Trial. JAMA Dermatol. Published online September 25, 2024. doi:10.1001/jamadermatol.2024.3897.}
2. ^{Elmets CA, Lim HW, Stoff B, et al. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019;81(3):775-804. doi:10.1016/j.jaad.2019.04.042.}