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

Autor:	Gelfand JM; Department of Dermatology, University of Pennsylvania, Philadelphia.; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia., Armstrong AW; Division of Dermatology, Department of Medicine, University of California, Los Angeles., Lim HW; Department of Dermatology, Henry Ford Health, Detroit, Michigan., Feldman SR; Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina., Johnson SM; Johnson Dermatology, Fort Smith, Arizona., Claiborne WCC; MD Claiborne & Associates Dermatology, New Orleans, Louisiana., Kalb RE; Department of Dermatology, SUNY at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York., Jakus J; Deparment of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, New York., Mangold AR; Department of Dermatology, Mayo Clinic, Scottsdale, Arizona., Flowers RH; Department of Dermatology, University of Virginia Health System, Charlottesville., Bhutani T; Department of Dermatology, University of California, San Francisco., Durkin JR; Department of Dermatology, University of New Mexico, Albuquerque., Bagel J; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, New York., Fretzin S; Dawes Fretzin Dermatology Group, Indianapolis, Indiana., Sheehan MP; Department of Dermatology, Indiana University School of Medicine, Indianapolis., Krell J; Total Dermatology, Birmingham, Alabama., Reeder M; Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison., Kaffenberger J; Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus., Kartono F; MI Skin Center, Northville, Michigan., Takeshita J; Department of Dermatology, University of Pennsylvania, Philadelphia.; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia., Bridges AM; Patient advocate and LITE study stakeholder committee member, Atlanta, Georgia., Fielding E; Patient advocate and LITE study stakeholder committee member, Melbourne, Florida., Nehal US; MIT Sloan School of Management, Cambridge, Massachusetts., Schaecher KL; University of Utah Health Plans, Murray., Howard LM; National Psoriasis Foundation, Alexandria, Virginia., Eakin GS; National Psoriasis Foundation, Alexandria, Virginia., Báez S; Department of Dermatology, University of Pennsylvania, Philadelphia., Bishop BE; Department of Dermatology, University of Pennsylvania, Philadelphia., Fitzsimmons RC Jr; Department of Dermatology, University of Pennsylvania, Philadelphia., Papadopoulos M; Department of Dermatology, University of Pennsylvania, Philadelphia., Song WB; Department of Dermatology, University of Pennsylvania, Philadelphia., Linn KA; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia., Hubbard RA; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.; Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island., Shin DB; Department of Dermatology, University of Pennsylvania, Philadelphia., Callis Duffin K; Department of Dermatology, University of Utah School of Medicine, Salt Lake City.
Jazyk:	angličtina
Zdroj:	JAMA dermatology [JAMA Dermatol] 2024 Dec 01; Vol. 160 (12), pp. 1320-1328.
DOI:	10.1001/jamadermatol.2024.3897
Abstrakt:	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. Trial Registration: ClinicalTrials.gov Identifier: NCT03726489.
Databáze:	MEDLINE
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