Adding NB-UVB Phototherapy to Dupilumab Can Lead to Faster Remission of Severe AD

Narrow-band ultraviolet B (NB-UVB) phototherapy can provide a faster remission of severe atopic dermatitis (AD) in the first few weeks of dupilumab therapy, researchers reported in Dermatology.

The pilot study enrolled adult patients with severe AD in a 2:1 ratio to receive treatment with dupilumab alone (group 1; n=30) or dupilumab plus NB-UVB phototherapy (group 2; n=15) for 12 weeks. After the 12th week, all patients received dupilumab only. Follow-up was conducted after 16 weeks, and clinician-oriented and patient-oriented scores were assessed at baseline and after 4, 12, and 16 weeks.

The analysis included 45 adult patients. Group 1 patients had a mean age of 40 years (±15.3) and 19 were men. Group 2 had a mean age of 42 years (±15.8) and 10 were men. NB-UVB phototherapy previously had been administered to 12 patients (40%) in group 1 and 7 patients (46.7%) in group 2 with partial and temporary improvements.

For both groups, all scores demonstrated a statistically significant improvement from baseline to 4, 12, and 16 weeks (P ≤.01). Both treatment regimens were well tolerated and very effective on all measured scores— Eczema Area and Severity Index 75 (EASI), Scoring Atopic Dermatitis (SCORAD), body surface area (BSA), Numerical Rating Scale (NRS) of itching, NRS of sleep loss, Dermatological Life Quality Index (DLQI), Patient-Oriented Eczema Measure (POEM), and Hospital Anxiety and Depression Scale (HADS).

“Both dupilumab alone and the combined regimen of dupilumab plus NB-UVB phototherapy were very effective and well tolerated,” stated the study authors. “The combined regimen led to a more robust clinical improvement of lesions and relief of symptoms after 4 weeks. However, after 12 weeks, the additional therapeutic effect of phototherapy weakened.”

Dupilumab caused only minor and transitory adverse effects, and also “we did not observe any short-term side effects to NB-UVB phototherapy as we used a protocol with low UV initial doses and cautious UV dose increments,” according to the investigators.

The researchers noted that the experimental design of their study did not allow them to compare the clinical effects of the treatment regimens with a phototherapy-alone regimen.

“Our findings suggest that the combination of dupilumab with a short (≤12 weeks) treatment cycle of NB-UVB phototherapy can be a simple and effective strategy to have a quicker improvement of itching and AD lesions,” the investigators concluded. “However, the combined protocol does not improve further long-term (>12 weeks) treatment results of dupilumab alone, and therefore, due to the higher costs and the greater commitment of the patient to go to the phototherapy centre, its use seems indicated only for patients who require a more rapid improvement of the disease.”

Reference

Rossia M, Rovatia C, Arisi M, et al. A short cycle of narrow-band UVB phototherapy in the early phase of dupilumab therapy can provide a quicker improvement of severe atopic dermatitis. Dermatology. Published online January 5, 2021. doi:10.1159/000512456