Clearance and remission duration to UVB phototherapy

[Fred]

This study investigated whether selected clinical/serum biomarkers were associated with remission duration, and psoriasis clearance at the end of phototherapy.

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Background:
Remission duration and treatment response following phototherapy for psoriasis are highly variable and factors influencing these are poorly understood.

Objectives:
Our primary outcome was to investigate whether selected clinical/serum biomarkers were associated with remission duration, and secondly with psoriasis clearance at the end of phototherapy. In addition, we looked at whether early trajectory of UVB clearance was associated with final clearance outcome.

Methods:
We performed a prospective cohort study of 100 psoriasis patients, routinely prescribed Narrowband UVB and measured selected clinical and biochemical biomarkers, including weekly PASI (psoriasis-area-and-severity-index) scores. Patients were followed up for 18-months.

Results:
The median time to relapse was 6-months (95% CI 5-18) if PASI90 was achieved, and 4-months (95% CI 3-9) if less than PASI90 was achieved. Achieving PASI100 did not result in prolonged remission.
On UVB completion, the median final PASI (n=96) was 1.0 (IQR 0.5, 1.6) with 78 (81%) achieving PASI75 and 39 (41%) achieving PASI90. Improved PASI90 response was significantly associated with lower BMI, higher baseline PASI, non-smoking status and lower cumulative NbUVB. Serum levels of C reactive protein (CRP) and vitamin D were not associated with clearance or remission duration.
Early treatment response from weeks 2-3 was predictive of final outcome. For example, achieving PASI30 at week 3 was significantly associated with PASI90 at the end of the course (36/77 (51%) versus 2/24 (8%), p < 0.001).

Conclusions:
Raised BMI and positive smoking-status predicted poorer phototherapy response. For the first time, we have shown that PASI clearance trajectory over the first 2-3 weeks of UVB, can predict psoriasis clearance. This is an important new step towards developing psoriasis personalised prescribing, which can now be formally tested in clinical trials. These simple clinical measures can be used to inform patient treatment expectations; allowing treatment modifications and/or switching to alternative therapies.

Source: onlinelibrary.wiley.com

*Funding: Early view funding unknown

[Turnedlight]

Another treatment which they shouldn’t make everyone go on.
It’s discriminatory against people who burn easily.. I don’t get the bmi thing, why it makes a difference? but even when I was slim I know I still would’ve burned to a crisp in the hospital sunburn cabinet.

[Caroline]

In the Netherlands they have researched the possibility of a low dose, long term, regular (every day) treatment.
Results appear to be very good, but take a long time.
Advantage:
- low dose, so never burning of the skin
- no fear for skin cancer, they were looking after that very carefully.
- skin gets a little tougher and even more resistant against skin cancer problems
- very stable clearance
- can be used every day, they have made lamps for under the shower. It’s called sunshower.

Disadvantage:
- if you have very much psoriasis, it can take a long time to work as the dose is so low
- there is only one reseach, there is no follow up research yet
- it is not in the guidelines, as the derms are very slow to adopt it and the derms state there is no follow up research, which, conservative as they are, is still not started. It is kind of a chicken and egg problem, which can be seen more in the medical world.
So they keep to the old. Very damaging approach.

There has been an article in the magazine of the Dutch association. I can photo copy it, but it is written in Dutch, still I can photocopy it, OCR it, google translate it, if anyone is interested.

Researchers were a dermatologist with light treatments as a speciality (one of the ones that are looking outside of the boundaries) and a biologist/technician on light waves etc.

[KatT]

This is something that was never proposed to me as a treatment option.  Probably because I had too much psoriasis.

And if it was offered today, I would refuse it because of my lupus as apparently sun causes flares which I really want to avoid