Combination Ultraviolet-Based Phototherapy More Effective at Treating Psoriasis

All combinatorial ultraviolet (UV)-based therapy regimens for psoriasis were more effective than UV monotherapy, a network meta-analysis published in the Annals of Medicine found.

Investigators with Xiangya Hospital in Changsha Hunan, China searched publication databases through January 2021 for studies of UV-based phototherapy for the treatment of moderate to severe psoriasis. The primary efficacy outcome was the percentage of patients achieving a 75% or greater improvement of Psoriasis Area and Severity Index (PASI75) and the primary safety outcome was the percentage of patients withdrawing due to adverse events (AEs).

This analysis comprised data from 32 studies with 2120 total patients median aged 41.5 years; 61.6% were men.

The most effective treatment at achieving PASI75 was combined adjuvant therapy with psoralen UV-based phototherapy with vitamin A (cPUVA; surface under the cumulative ranking [SUCRA], 86.0%), followed by combined adjuvant therapy with UV-based phototherapy with vitamin B (cUVB; SUCRA, 79.0%), and UV-based phototherapy with vitamin B (UVB; SUCRA, 32.0%). For achieving PASI75 and above, the most effective treatments were cPUVA (SICRA, 81.1%), cUVB (SUCRA, 78.4%), and UVB (SUCRA, 23.3%).

For PASI improvement in general, cPUVA performed significantly better than psoralen UV-based phototherapy with vitamin A (PUVA; standardized mean difference [SMD], 2.31; 95% CI, 0.48-4.13) and UVB (SMD, 2.17; 95% CI, 0.15-4.18) and cUVB performed better than UVB (SMD, 1.22; 95% CI, 0.05-2.39).

The highest withdrawal rate due to AEs was observed for PUVA (SUCRA, 46.6%), followed by cUVB (SUCRA, 54.9%), and the combination of PUVA and UVB (cAB; SUCRA, 52.5%).

Fewer cases of erythema were observed among UVB (SUCRA, 65.8%) and cUVB (SUCRA, 61.0%) recipients.

Together, the most effective and safest therapy was PUVA plus calcium and vitamin D (clusterank value, 7393.2).

This major limitation of this study was that the investigators observed dubious asymmetry in the funnel plots due to small-study effects.

These data indicated to the investigators that all combinatorial therapy regimens were superior to UV monotherapy without increasing risk for AEs. The study authors concluded that cPUVA and cUVB combined with calcium and vitamin D could be potential safe and effective first choice therapies for patients with moderate to severe psoriasis.

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. 2022;54(1):159-169. doi:10.1080/07853890.2021.2022187