Systematic Review of UV-Based Therapy for Psoriasis

American Journal of Clinical Dermatology volume 14, pages87–109(2013)Cite this article

Abstract

Background

UV-based therapies, which include narrow-band (NB) UVB, broad-band (BB) UVB, and psoralen and UVA (PUVA), are well known treatment options for moderate to severe plaque psoriasis. However, there are limited evidence-based reviews on their efficacy, short-term safety, and tolerability.

Aim

The aim of the study was to evaluate the efficacy, short-term safety, and tolerability of UV-based therapy in the treatment of adults with moderate to severe plaque psoriasis.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating NB-UVB, BB-UVB, and PUVA in adults with moderate to severe plaque-type psoriasis. Our efficacy outcomes were ≥ Psoriasis Area and Severity Index (PASI)-75 and clearance. We evaluated the short-term safety and tolerability from the percentage of adverse effects and withdrawal due to adverse effects, respectively.

Results

Forty-one RCTs, with a total of 2,416 patients, met the eligibility criteria and were included in the analysis. In regard to PASI-75 in monotherapy trials, PUVA (mean: 73 %, 95 % CI 56–88) was the most effective modality. Trials with BB-UVB also showed a high PASI-75 (73 %) but with a wide CI (18–98) due to heterogeneity of the total available three studies. This was followed by NB-UVB (mean: 62 %, 95 % CI 45–79) then bath PUVA (mean: 47 %, 95 % CI 30–65). In regard to clearance in the monotherapy trials, PUVA (mean: 79 %, 95 % CI 69–88) was superior to NB-UVB (mean: 68 %, 95 % CI 57–78), BB-UVB (mean: 59 %, 95 % CI 44–72), and bath PUVA (mean: 58 %, 95 % CI 44–72). The percentages of asymptomatic erythema development in monotherapy trials were 64 % for BB-UVB, 57 % for NB-UVB, 45 % for PUVA, and 34 % for bath PUVA. Symptomatic erythema or blistering percentages for the monotherapy trials were as follows: 7.8 % for NB-UVB, 2 % for BB-UVB, 17 % for PUVA, and 21 % for bath PUVA. The percentages of withdrawal due to adverse effects were 2 % for NB-UVB, 4.6 % for BB-UVB, 5 % for PUVA, and 0.7 % for bath PUVA monotherapy trials.

Conclusions

As a monotherapy, PUVA was more effective than NB-UVB, and NB-UVB was more effective than BB-UVB and bath PUVA in the treatment of adults with moderate to severe plaque-type psoriasis, based on clearance as an end point. Based on PASI-75, the results were similar except for BB-UVB, which showed a high mean PASI-75 (73 %) that was similar to PUVA, but with a wide CI (18–98). The short-term adverse effects were mild as shown by the low rate of withdrawal due to adverse effects.

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Acknowledgments

We would like to thank Ms. Nandita S. Mani for her help in the literature search and editing of the manuscript. No sources of funding were used to prepare this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this article.

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Affiliations

  1. Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait

    Fahad Almutawa

  2. Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA

    Naif Alnomair

  3. Department of Public Health Science, Henry Ford Hospital, Detroit, MI, USA

    Yun Wang

  4. Department of Dermatology, Henry Ford Medical Center-New Center One, 3031 West Grand Blvd Suite 800, Detroit, MI, 48202, USA

    Iltefat Hamzavi & Henry W. Lim

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  1. Fahad Almutawa
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  2. Naif Alnomair
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  3. Yun Wang
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  4. Iltefat Hamzavi
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  5. Henry W. Lim
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Correspondence to Henry W. Lim.

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Almutawa, F., Alnomair, N., Wang, Y. et al. Systematic Review of UV-Based Therapy for Psoriasis. Am J Clin Dermatol 14, 87–109 (2013). https://doi.org/10.1007/s40257-013-0015-y

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Keywords

  • Psoriasis
  • Plaque Psoriasis
  • Etretinate
  • Calcipotriol
  • Acitretin