Systematic review of UV-based therapy for psoriasis

Area of Science:

• Dermatology
• Phototherapy
• Evidence-based medicine

Background:

• UV-based therapies like narrow-band (NB) UVB, broad-band (BB) UVB, and psoralen and UVA (PUVA) are established treatments for moderate to severe plaque psoriasis.
• Limited evidence-based reviews exist on the comparative efficacy, short-term safety, and tolerability of these UV modalities.

Purpose of the Study:

• To systematically evaluate the efficacy, short-term safety, and tolerability of NB-UVB, BB-UVB, and PUVA for treating adults with moderate to severe plaque psoriasis.
• To provide an evidence-based review to guide clinical decision-making in psoriasis phototherapy.

Main Methods:

• A systematic review and meta-analysis of 41 randomized controlled trials (RCTs) involving 2,416 adult patients with moderate to severe plaque psoriasis.
• Efficacy was assessed by Psoriasis Area and Severity Index (PASI)-75 and lesion clearance.
• Short-term safety and tolerability were evaluated based on adverse event percentages and withdrawal rates due to adverse effects.

Main Results:

• In monotherapy, PUVA showed the highest efficacy for PASI-75 (73%) and clearance (79%).
• NB-UVB (62% PASI-75, 68% clearance) and BB-UVB (73% PASI-75, 59% clearance) also demonstrated significant efficacy, though BB-UVB results had high heterogeneity.
• Adverse effects like erythema were common, but symptomatic erythema/blistering and withdrawal rates due to adverse effects were generally low across all treatments.

Conclusions:

• PUVA is the most effective monotherapy for moderate to severe plaque psoriasis, followed by NB-UVB, then BB-UVB and bath PUVA, based on clearance rates.
• PASI-75 results were similar, with BB-UVB showing comparable efficacy to PUVA but with wider confidence intervals.
• UV-based therapies are associated with mild short-term adverse effects, indicated by low withdrawal rates, making them viable treatment options.