Ultraviolet B phototherapy was associated with greater benefit than adalimumab in improving overall health-related quality of life (HRQoL) among patients with psoriasis, but both treatments were effective for improving both skin-related quality of life and HRQoL, according to a randomized controlled study published in the Journal of the American Academy of Dermatology.1
A total of 97 patients with psoriasis were enrolled from multiple centers to participate in the 12-week trial. Patients (mean age, 43.5 years; median Psoriasis Area and Severity Index score, 16.7) were randomly assigned at baseline to adalimumab injections (n=33), placebo injections (n=31), or 170 narrowband ultraviolet B phototherapy (n=33).2 Adalimumab and placebo were administered via subcutaneous injections in a double-blind manner, starting with 80 mg at baseline followed by 40 mg maintenance doses every other week for a total of 12 weeks. Ultraviolet phototherapy was administered 3 times weekly in an unblinded fashion without the use of a sham control.
Patient-reported outcomes were assessed at 12 weeks, as were changes in the Dermatology Life Quality Index and EQ-5D-3L every 4 weeks. Questionnaires evaluated dermatology-specific quality of life and generic health status.
Compared with placebo, patients were more likely to achieve the minimal clinically important difference in DLQI if they were treated with adalimumab (odds ratio [OR], 2.88; 95% CI, 1.02-8.17) and phototherapy (OR, 8.83; 95% CI, 2.47-31.57). Similarly, patients who underwent phototherapy had higher odds of achieving the minimal clinically important difference for the EQ-5D-3L Index score compared with placebo (OR, 9.78; 95% CI, 2.99-31.95).
Patients treated with adalimumab and phototherapy had higher scores in the individual EQ-5D-3L domains compared with placebo; however, only phototherapy achieved statistical significance in the pain domain vs placebo (OR of having “no problems” vs “any problems,” 5.97; 95% CI, 1.95-18.33). In contrast, participants in the phototherapy group were more likely to achieve the minimal clinically important difference for the EQ-5D-3L Index score than participants in the adalimumab group (OR, 4.07; 95% CI, 1.42-11.70).
Limitations of the study include its small sample size, the inability to have a sham procedure for phototherapy, and the low proportion of female participants in the overall cohort (30.9%).
Although phototherapy appears promising for improving psoriasis HRQoL, limitations of phototherapy include “its distribution (90% of counties in the US have no physicians that offer phototherapy) and its inconvenience given the modern-day difficulties for patients who do not live near a physician whom offers phototherapy to travel to the office for regular treatments,” the researchers wrote.
The authors disclose financial relationships with AbbVie, Janssen, Lilly, Leo, Novartis, and several other pharmaceutical organizations in their paper.
1. Noe MH, Wan MT, Shin DB, et al. Patient-reported outcomes of adalimumab, phototherapy, and placebo in the vascular inflammation in psoriasis trial: a randomized controlled study [published online June 1, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.05.080.
2. ClinicalTrials.gov. Vascular inflammation in psoriasis trial (the VIP trial) (VIP). NCT01553058. https://clinicaltrials.gov/ct2/show/NCT01553058. Accessed Jun 24, 2019.