Home- vs Office-Based Narrowband UV-B Phototherapy for Patients With Psoriasis The LITE Randomized Clinical Trial

被引：0

作者：

Gelfand, Joel M. ^{[1
,2
]}

Armstrong, April W. ^{[3
]}

Lim, Henry W. ^{[4
]}

Feldman, Steven R. ^{[5
]}

Johnson, Sandra M. ^{[6
]}

Claiborne, W. C. Cole ^{[7
]}

Kalb, Robert E. ^{[8
]}

Jakus, Jeannette ^{[9
]}

Mangold, Aaron R. ^{[10
]}

Flowers, R. Hal ^{[11
]}

Bhutani, Tina ^{[12
]}

Durkin, John R. ^{[13
]}

Bagel, Jerry ^{[14
]}

Fretzin, Scott ^{[15
]}

Sheehan, Michael P. ^{[16
]}

Krell, James ^{[17
]}

Reeder, Margo ^{[18
]}

Kaffenberger, Jessica ^{[19
]}

Kartono, Francisca ^{[20
]}

Takeshita, Junko ^{[1
,2
]}

Bridges, Alisha M. ^{[21
]}

Fielding, Eric ^{[22
]}

Nehal, Umbereen S. ^{[23
]}

Schaecher, Kenneth L. ^{[24
]}

Howard, Leah M. ^{[25
]}

Eakin, Guy S. ^{[25
]}

Baez, Suzette ^{[1
]}

Bishop, Brooke E. ^{[1
]}

Fitzsimmons, Robert C. ^{[1
]}

Papadopoulos, Maryte ^{[1
]}

Song, William B. ^{[1
]}

Linn, Kristin A. ^{[2
]}

Hubbard, Rebecca A. ^{[2
,26
]}

Shin, Daniel B. ^{[1
]}

Callis Duffin, Kristina ^{[27
]}

机构：

[1] Univ Penn, Dept Dermatol, 3400 Civic Ctr Blvd, Philadelphia, PA 19104 USA

[2] Univ Penn, Perelman Sch Med, Dept Biostat Epidemiol & Informat, Philadelphia, PA USA

[3] Univ Calif Los Angeles, Dept Med, Div Dermatol, Los Angeles, CA USA

[4] Henry Ford Hlth, Dept Dermatol, Detroit, MI USA

[5] Wake Forest Univ, Sch Med, Dept Dermatol, Winston Salem, NC USA

[6] Johnson Dermatol, Ft Smith, AR USA

[7] MD Claiborne & Associates Dermatol, New Orleans, LA USA

[8] SUNY Buffalo, Sch Med & Biomed Sci, Dept Dermatol, Buffalo, NY USA

[9] SUNY Downstate Hlth Sci Univ, Dept Dermatol, Brooklyn, NY USA

[10] Mayo Clin, Dept Dermatol, Scottsdale, AZ USA

[11] Univ Virginia Hlth Syst, Dept Dermatol, Charlottesville, VA USA

[12] Univ Calif San Francisco, Dept Dermatol, San Francisco, CA USA

[13] Univ New Mexico, Dept Dermatol, Albuquerque, NM USA

[14] Icahn Sch Med Mt Sinai, Dept Dermatol, New York, NY USA

[15] Dawes Fretzin Dermatol Grp, Indianapolis, IN USA

[16] Indiana Univ Sch Med, Dept Dermatol, Indianapolis, IN USA

[17] Total Dermatol, Birmingham, AL USA

[18] Univ Wisconsin, Sch Med & Publ Hlth, Dept Dermatol, Madison, WI USA

[19] Ohio State Univ, Wexner Med Ctr, Dept Dermatol, Columbus, OH USA

[20] MI Skin Ctr, Northville, MI USA

[21] Patient Advocate & LITE Study Stakeholder Comm, Atlanta, GA USA

[22] Patient Advocate & LITE Study Stakeholder Comm, Melbourne, FL USA

[23] MIT, Sloan Sch Management, Cambridge, MA USA

[24] Univ Utah Hlth Plans, Murray, UT USA

[25] Natl Psoriasis Fdn, Alexandria, VA USA

[26] Brown Univ, Sch Publ Hlth, Dept Biostat, Providence, RI USA

[27] Univ Utah, Sch Med, Dept Dermatol, Salt Lake City, UT USA

来源：

JAMA DERMATOLOGY | 2024年 / 160卷 / 12期

关键词：

THERAPY; REMISSION; DURATION; MORTALITY; SEVERITY; MODERATE; RISK;

D O I：

暂无

中图分类号：

R75 [皮肤病学与性病学];

学科分类号：

100206 ;

摘要：

Importance Office-based phototherapy is cost-effective for psoriasis but difficult to access. Home-based phototherapy is patient preferred but has limited clinical data, particularly in patients with darker skin. Objective To compare the effectiveness of home- vs office-based narrowband UV-B phototherapy for psoriasis. Design, Setting, and Participants The Light Treatment Effectiveness study was an investigator-initiated, pragmatic, open-label, parallel-group, multicenter, noninferiority randomized clinical trial embedded in routine care at 42 academic and private clinical dermatology practices in the US. Enrollment occurred from March 1, 2019, to December 4, 2023, with follow-up through June 2024. Participants were 12 years and older with plaque or guttate psoriasis who were candidates for home- and office-based phototherapy. Interventions Participants were randomized to receive a home narrowband UV-B machine with guided mode dosimetry or routine care with office-based narrowband UV-B for 12 weeks, followed by an additional 12-week observation period. Main Outcomes and Measures The coprimary effectiveness outcomes were Physician Global Assessment (PGA) dichotomized as clear/almost clear skin (score of <= 1) at the end of the intervention period and Dermatology Life Quality Index (DLQI) score of 5 or lower (no to small effect on quality of life) at week 12. Results Of 783 patients enrolled (mean [SD] age, 48.0 [15.5] years; 376 [48.0%] female), 393 received home-based phototherapy and 390 received office-based phototherapy, with 350 (44.7%) having skin phototype (SPT) I/II, 350 (44.7%) having SPT III/IV, and 83 (10.6%) having SPT V/VI. A total of 93 patients (11.9%) were receiving systemic treatment. At baseline, mean (SD) PGA was 2.7 (0.8) and DLQI was 12.2 (7.2). At week 12, 129 patients (32.8%) receiving home-based phototherapy and 100 patients (25.6%) receiving office-based phototherapy achieved clear/almost clear skin, and 206 (52.4%) and 131 (33.6%) achieved DLQI of 5 or lower, respectively. Home-based phototherapy was noninferior to office-based phototherapy for PGA and DLQI in the overall population and across all SPTs. Home-based phototherapy, compared to office-based phototherapy, was associated with better treatment adherence (202 patients [51.4%] vs 62 patients [15.9%]; P < .001), lower burden of indirect costs to patients, and more episodes of persistent erythema (466 of 7957 treatments [5.9%] vs 46 of 3934 treatments [1.2%]; P < .001). Both treatments were well tolerated with no discontinuations due to adverse events. Conclusions and Relevance In this randomized clinical trial, home-based phototherapy was as effective as office-based phototherapy for plaque or guttate psoriasis in everyday clinical practice and had less burden to patients.

引用

页码：1320 / 1328

页数：9

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