SOURCE: Kristina Fiore, Staff Writer, MedPage Today
Published: May 08, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
TITLE: Home phototherapy is comparable to hospital-based ultraviolet B treatment for psoriasis patients, researchers have found.
In a randomized controlled trial, home phototherapy was as safe and effective as hospital-based treatment, Mayke Koek, M.D., of the University Medical Center Utrecht in the Netherlands, and colleagues reported online in BMJ.
“We regard home ultraviolet B phototherapy to be a worthy alternative to standard outpatient ultraviolet B phototherapy for patients with psoriasis,” the researchers concluded.
They explained that many patients who could benefit from phototherapy don’t get it because of time constraints: treatment typically involves going to the hospital three times a week for eight to 10 weeks.
Also, some dermatologists believe that home phototherapy is inferior to hospital treatment and carries more risks, such as inaccurate dosimetry, phototoxicity, and unsupervised continuation of irradiation. The researchers said there is little evidence for this.
So the present study looked at 196 psoriasis patients from 14 hospital dermatology departments in the Netherlands who received either home- or hospital-based phototherapy.
Home therapy patients used a TL-01 home phototherapy unit, while those who came to the hospital for treatment received standard, narrowband ultraviolet B phototherapy.
The researchers found that home phototherapy was as safe and effective as outpatient phototherapy, both clinically and in terms of quality of life.
A total of 82% of patients treated at home reached a treatment effect as measured by the self-administered psoriasis area and severity index (SAPASI), compared with 79% of those treated in an outpatient setting.
Likewise, 70% reached treatment effect as measured by the clinically assessed psoriasis area and severity index (PASI), compared with 73% of outpatients.
The treatment effects were significant across all groups (P<0.001).
As for safety concerns, the researchers found that patients treated themselves at home more frequently than they would have been treated at the hospital. But the cumulative dose they received by the end of treatment was only slightly higher than hospital-treated patients.
They found that regardless of treatment, 87% of patients had at least one occurrence of mild erythema, while 58% reported burning sensations, 39% had severe erythema, and 6% had blistering. No differences were observed between groups.
“Our results refute the widespread fear of more acute safety risks with ultraviolet B phototherapy used at home,” the researchers said.
They also found that the burden of undergoing phototherapy was significantly lower for patients treated at home (P<0.001).
Quality of life increased equally, regardless of treatment, but those treated at home were more likely to rate their experience with the therapy as “excellent” (42% versus 23%, P=0.001).
The researchers concluded that phototherapy administered at home is “equally safe and equally effective, both clinically and for quality of life, as ultraviolet B phototherapy administered in an outpatient setting.”
In an accompanying editorial, Alex Anstey, M.D., of Royal Gwent Hospital, called the study “pragmatic” and said an economic assessment of different phototherapy service models is now needed.
“This should include the costs of the equipment, costs of teaching patients how to use the equipment, and costs for a clinical governance system within which home phototherapy can operate,” Dr. Anstey said.
He added that dermatologists “should reflect on the shortcomings of current phototherapy services, where many patients are excluded because they live too far from their local unit. The case for home provision of UVB phototherapy for psoriasis is most persuasive in sparsely populated areas.”
Primary source: British Medical Journal
Koek MBG, et al “Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicenter randomized controlled non-inferiority trial (PLUTO study)” BMJ 2009; DOI: 10.1136/bmj.b1542.