Fumaric acid esters in combination with narrowband ultraviolet B for psoriasis

[Fred]

This study suggests using short term narrowband ultraviolet B (NB‐UVB) can benefit the effect of Fumaric acid esters (FAE) in the treatment of psoriasis.

Quote:

---

Background:
Fumaric acid esters (FAE) are safe and effective in patients with moderate‐to‐severe psoriasis but have a slow onset of action. A short‐term combination with narrowband ultraviolet B (NB‐UVB) may substantially accelerate the therapeutic response in the induction phase of treatment.

Objectives:
To assess the synergistic effect of a 6‐week course of NB‐UVB phototherapy in addition to FAE in adults with moderate‐to‐severe plaque psoriasis.

Methods:
In this randomized, assessor‐masked trial, patients with a Psoriasis Area and Severity Index (PASI) of ≥ 10 and a body surface area affected of ≥ 10 were randomized either to monotherapy with FAE (n = 16) or a combination of FAE with NB‐UVB (n = 14). The primary outcome parameter of the study was the mean PASI reduction after 6 weeks of treatment. In addition, the PASI 75 response (≥ 75% improvement from baseline PASI), the Psoriasis Log‐based Area and Severity Index (PLASI) and the Dermatology Life Quality Index (DLQI) were assessed as secondary outcome measures.

Results:
In total, 30 patients (19 men, 11 women; median age 52 years, interquartile range 36–56) were analysed. The mean reduction in PASI after 6 weeks was significantly greater with the combination treatment than with FAE monotherapy (P = 0·016). This was paralleled by a much faster improvement in the DLQI in the combination group than in the FAE‐monotherapy group.

Conclusions:
Adding a 6‐week course of NB‐UVB to FAE both accelerates and augments the therapeutic response during the early phase of treatment and increases quality of life in patients with moderate‐to‐severe plaque psoriasis.

Source: onlinelibrary.wiley.com

*Funding: None declared.

[jiml]

That’s very good to read, as FAE’s can take a while to work and some may  assume that it won’t work and move to something else, which is a shame as when it works it has been proven to give long term clearance, so at the start of treatment combining it with NB/UVB is a great idea to accelerate clearance

It is also a possibility with FAE’s to use topical ointments to speed up initial response time

[Bill]

My guess is that DMF is sensitising the T cells and dendrocytes to the UVB. Thanks, Fred.

[Maryam]

Yes! My dermatologist who prescribed me DMF told me to get in the sun whenever possible cause it would benefit the action of the DMF.

[Caroline]

Yes! My dermatologist who prescribed me DMF told me to get in the sun whenever possible cause it would benefit the action of the DMF.

That seems to be a very smart dermatologist then.. Stick to him/her.

I did not know this yet, but love the sun anyway.

[jiml]

Yes! My dermatologist who prescribed me DMF told me to get in the sun whenever possible cause it would benefit the action of the DMF.

I always get out in the sun as much as I can in the summer as I have always believed it helped me

[Maryam]

Yes! My dermatologist who prescribed me DMF told me to get in the sun whenever possible cause it would benefit the action of the DMF.

That seems to be a very smart dermatologist then.. Stick to him/her.

I did not know this yet, but love the sun anyway.  

I wish I could have stayed with her, but it is a small practice and they are not able to prescribe the biologicals. I am now at UMC Utrecht. But I have to say; I seem to be very lucky with my dermatologist as I got stelara when I asked for it