A comparison of three times vs. five times weekly narrowband ultraviolet B phototherapy for the treatment of chronic plaque psoriasis.
ABSTRACT Narrowband ultraviolet B (NB-UVB) phototherapy is an effective treatment for psoriasis.
To compare the effects of three and five times weekly NB-UVB phototherapy in the treatment of chronic plaque psoriasis. Methods: Sixty-five patients with chronic plaque psoriasis were allocated to receive three or five times weekly NB-UVB, starting at low dose.
Among the patients who completed the study, clearance was achieved in 18 out of 23 patients (78%) in the three times weekly group and in 15 out of 22 patients (68%) in the five times weekly group. The difference was not statistically significant (P=0.44). No statistically significant differences were found between the two groups in the number of treatments (P=0.95), cumulative UVB dose (P=0.51), and rate of side-effects. Length of the treatment period was significantly shorter in the five times weekly group (P<0.001). At the end of treatment, the mean psoriasis area and severity index score was lower in the three times weekly group (P=0.02).
We recommend three times weekly NB-UVB for chronic plaque psoriasis; however, the more rapid clearance of psoriasis with five times weekly phototherapy may justify using this method in some patients.
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ABSTRACT: BACKGROUND: Topical therapies are a mainstay of psoriasis treatment, but they vary substantially in terms of costs. OBJECTIVES: To determine the cost-effectiveness and optimal treatment sequence for psoriasis of the trunk, limbs and scalp. METHODS: Probabilities of response from a network meta-analysis were used to determine the short-term efficacy of topical therapies. Longer-term outcomes, including relapse, were informed by published evidence and clinical opinion. Benefits of treatment were measured as quality-adjusted life years (QALYs). Direct costs included topical agents, primary and secondary care visits and second-line therapies for treatment failures. RESULTS: For trunk and limbs, initial treatment with two-compound formulation (TCF) product containing vitamin D and potent corticosteroid provided the most QALYs, followed by separate morning and evening application of vitamin D and potent corticosteroid (TCA (am/pm)), and then twice daily potent corticosteroids. Twice daily potent corticosteroid was the most cost-effective first-line strategy (ICER £20,000 per QALY), followed by TCA (am/pm) (£22,658 per QALY) and TCF product (£179,439 per QALY). For scalp psoriasis, initial treatment with very potent corticosteroids generated the most QALYs, followed by TCF product and then potent corticosteroids. Very potent corticosteroids were most cost effective, but if too aggressive, then potent corticosteroids were optimal followed by TCF product (£219,846 per QALY). Cost effectiveness of second and third-line topical agents varied with assumptions made. CONCLUSIONS: Potent corticosteroids, used alone or in combination with vitamin D are most cost-effective for patients with psoriasis of the trunk and limbs. Potent or very potent corticosteroids are most cost-effective for patients with scalp psoriasis.British Journal of Dermatology 02/2013; · 3.76 Impact Factor
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ABSTRACT: An agent-based model (ABM) was constructed to integrate dermatological data from literature on the interactions of the skin and immune system cells in psoriasis and study the conflicting roles of ultraviolet radiation (UVR) as a disease treatment and as a carcinogenic agent. Backed by clinical judgement from an expert dermatologist and validated with data available from literature, the model was subjected to various experimental scenarios which would be costly or even not feasible under clinical or laboratory settings. Lastly, the model was used to suggest possible therapeutic regimens by subjecting it to multi-objective evolutionary optimization using the Non-dominated Sorting Genetic Algorithm-II (NSGA-II) which is capable of dealing with the apparently conflicting aspects of the system. Results of the ABM-driven evolutionary optimization suggested some alternatives that are well-balanced in terms of the therapeutic and harmful effects even with adjunct treatments such topical corticosteroids or in the presence of certain constraints such as limited time for therapy and decreased patient tolerance to aggressive dosages.HNICEM 2011; 03/2011
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ABSTRACT: The combination of etanercept, a tumour necrosis factor α inhibitor, with narrow-band ultraviolet B (NB-UVB) phototherapy has recently been reported to be effective in moderate-to-severe plaque psoriasis, yielding better results than either monotherapy. To assess the efficacy and safety of this combined treatment using the lower approved etanercept dosage. In this single-arm open-label study patients received etanercept 50 mg once weekly combined with NB-UVB phototherapy three times weekly for 8 weeks, followed by etanercept alone until week 12. We evaluated the proportion of patients achieving 75%, 90% and 100% improvement of their initial PASI score (PASI75, PASI90, and PASI100, respectively). Patients were 19 men and 14 women, mean age 48.3 years ± 12.1 standard deviation (SD) and mean baseline Psoriasis Area and Severity Index (PASI) score 22.5 ± 7.5. On treatment weeks 4, 8, and 12, 24.2%, 66.7%, and 81.8% of patients achieved PASI75; 8.0%, 15.1%, and 57.6% reached PASI90, and 0%, 6.0%, and 24.2% attained PASI100, respectively. There were no severe side effects. Low-dosage etanercept combined with NB-UVB phototherapy is an effective, safe and economical approach to treat moderate-to-severe plaque psoriasis. Further studies are clearly required to assess its long-term efficacy and safety.European journal of dermatology: EJD 06/2011; 21(4):568-72. · 1.95 Impact Factor