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Home UVB phototherapy for psoriasis safe, effective and preferred by patients

NEW YORK (Reuters Health) - Treatment with ultraviolet B (UVB) phototherapy is as safe and effective in the home setting as it is in a clinic, Dutch investigators report in the May 8 issue of BMJ Online First. Because patients with psoriasis can avoid traveling to a clinic several times a week for months, the burden of home treatment is lower, leading to greater patient satisfaction.

Studies have demonstrated the feasibility of home UVB therapy, but many dermatologists believe that it is inferior, citing fears of burns, carcinogenesis, and photoaging. Up until now, there have been no head-to-head studies comparing treatment in the two settings.

Study manager Dr. Mayke B. G. Koek at University Medical Center, Utrecht, and co-investigators conducted a multicenter randomized trial involving 196 adult subjects, 98 in each treatment arm. Patients' dermatologists prescribed narrowband UVB phototherapy for psoriasis varying in severity from mild to severe.

Treatment schedules and equipment were those normally used by the hospitals and home care institutions, and alterations to treatment were made at dermatologists' discretion. Outpatient treatment was provided at local hospitals two or three times a week, whereas patients treated at home underwent irradiation every other day.

Treatment effect according to scores on the psoriasis area and severity index (PASI) and the self-administered PASI (SAPASI) "was statistically significant within (all p < 0.001) and similar (p > 0.3) across both treatment groups," the team reports.

Achievement of at least a 50% decline in baseline PASI was 70% for home therapy and 73% in the outpatient group; corresponding values for SAPASI were 82% and 79%.

Neither mean cumulative dose nor occurrence of side effects differed between settings. Burden of treatment was rated significantly lower for those treated at home, Dr. Koek and associates found, and patient satisfaction was higher.

Thus, they conclude, "There is no need to select patients (for home treatment) based on their presumed higher intelligence, competence, responsibility, reliability, or compliance." They are reporting cost-effectiveness data in a separate publication.

"Dermatologists should reflect on the shortcomings of current phototherapy services, where many patients are excluded because they live too far from their local unit," Dr. Alex Anstey of Royal Gwent Hospital in Newport, UK, writes in a linked commentary.

"Experience in Germany, the US, the Netherlands, and Scotland confirms that it would be feasible and practical to implement home based UVB phototherapy," the editorialist adds.

BMJ 2009;338:b1542,b607.

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