Joel Gelfand, MD, MSCE: Phototherapy Utility in Psoriasis

Late-breaking data presented at the American Academy of Dermatology (AAD) 2024 Annual Meeting in San Diego, CA, this weekend showed phototherapy provided consistent benefit to patients with psoriasis regardless of at-home versus in-office setting of use.¹ The LITE study data presented by Joel Gelfand, MD, MSCE, also gave greater consideration to patient-reported outcomes of care, using Dermatology Life Quality Index (DLQI) as a primary measure of treatment efficacy.

The LITE study findings contribute data and rhetoric to a couple of popularizing trends in clinical dermatology research: the pursuit of refined treatment modalities, and the prioritization of patient satisfaction and convenience in care. In the second segment of an interview with HCPLive, Gelfand,director of the Center for Clinical Sciences in Dermatology and Psoriasis and Phototherapy Treatment Center at University of Pennsylvania Perelman School of Medicine, discussed the role of phototherapy in both those trends.

“I think the degree of effectiveness is actually kind of surprising to people, especially if you don't use this treatment regularly,” Gelfand said. “When we looked at people who were able to be adherent with treatment—they had to treat about twice a week, which is what we typically recommend—60% of people got clear or almost clear, 50% of people were what we would consider to be a PASI 90. That's comparable to some of our better biologics out there, and certainly probably better than our current oral medications under real-world, difficult-to-treat patients.”

What’s more, Gelfand said, many of the LITE study participants to derive significant benefit from phototherapy had history of treatment with biologic therapy as well as challenging comorbidities limiting their prior drug regimens. It all contributes toward proving phototherapy has a distinct role among psoriasis care options.

“That's an important thing to remember for our patients, that we have a lot of ways of managing their disease, and if we can make it more convenient for them or lower the barrier to care, they could do quite well with this modality,” Gelfand said.

Gelfand believes phototherapy can optimally serve as either a primary care option to patients who did not succeed with systemic therapies and biologics—or as a secondary option to those looking to approach clear disease after a successful drug regimen. He cited the phase 2 KNOCKOUT study—presented by Andrew Blauvelt, MD, MBA, at the AAD 2024 late-breaking sessions, as well—in which a high induction dose of risankizumab was associated with significant skin clearance and resident memory T cell reduction at 52 weeks.²

“Patients did great, right? But disease comes back in virtually all of them when it comes down to it,” Gelfand said. “So, imagine a scenario where as patients came in and disease was pretty severe, they get their 2 shots of high-dose of risankizumab—and then a year later it starts coming back a little bit, you have your home (phototherapy) machine, and you could clean up whatever you need to.”

The result could possibly be patients benefitting from an optimal and hopefully more cost-efficient treatment modality—designed to their convenience and capability to manage psoriasis on their own.

“Giving control to the patient, and the clinicians knowing the treatment is available when they need it, really empowers people,” Gelfand said.

References

1. ^{Kunzmann K. LITE Study Shows Similar Efficacy Between At-Home, In-Office Psoriasis Phototherapy. HCPLive. Published March 9, 2024. https://www.hcplive.com/view/lite-study-efficacy-home-in-office-psoriasis-phototherapy}
2. ^{Kunzmann K. High Risankizumab Induction Dose Rapidly Clears Psoriasis, Reduces Resident Memory Cells. HCPLive. Published March 9, 2024. https://www.hcplive.com/view/risankizumab-dose-clears-psoriasis-resident-memory-cells}