Home-based as good as office-based phototherapy for psoriasis

Phototherapy, whether performed at home or in the clinic office, helps improve outcomes in plaque or guttate psoriasis, with the home-based procedure being associated with less financial burden to patients, according to a study.

The Light Treatment Effectiveness study was an open-label, multicentre, noninferiority randomized clinical trial conducted within routine care. A total of 783 patients (mean age 48.0 years, 48.0 percent female) with plaque or guttate psoriasis who were candidates for phototherapy participated in the study.

The participants were randomly assigned to receive a home narrowband UV-B machine with guided mode dosimetry (n=393) or routine care with office-based narrowband UV-B (n=390) for 12 weeks. All participants were followed for an additional 12-week observation period.

Effectiveness was assessed using the co-primary outcomes of Physician Global Assessment (PGA) score of ≤1 (clear/almost clear skin) and Dermatology Life Quality Index (DLQI) score of not more than 5 (no to small effect on quality of life) at week 12.

Of the patients, 350 (44.7 percent) had skin phototype (SPT) I/II, 350 (44.7 percent) had SPT III/IV, and 83 (10.6 percent) had SPT V/VI. Ninety-three patients (11.9 percent) were receiving systemic treatment. At baseline, mean PGA was 2.7, and mean DLQI was 12.2.

At week 12, clear/almost clear skin occurred in 129 patients (32.8 percent) in the home-based group and in 100 patients (25.6 percent) in the office-based group. Furthermore, 206 (52.4 percent) and 131 (33.6 percent) patients in the respective groups achieved a DLQI score of 5 or lower. These numbers established the noninferiority of home-based to office-based phototherapy across all skin phototypes.

Compared with office-based phototherapy, home-based phototherapy was associated with significantly higher treatment adherence (51.4 percent vs 15.9 percent; p<0.001) and lower burden of indirect costs to patients but also more episodes of persistent erythema (5.9 percent vs 1.2 percent; p<0.001).

Both procedures were well tolerated, with no discontinuations due to adverse events.