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Meta-Analysis
. 2013 Oct 23;2013(10):CD009481.
doi: 10.1002/14651858.CD009481.pub2.

Narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen-ultraviolet A photochemotherapy for psoriasis

Xiaomei Chen  1 , Ming Yang, Yan Cheng, Guan J Liu, Min Zhang
Affiliations
Meta-Analysis

Narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen-ultraviolet A photochemotherapy for psoriasis

Xiaomei Chen et al. Cochrane Database Syst Rev. .

Abstract

Background: The most commonly used types of phototherapy for treating psoriasis are narrow-band ultraviolet B (NB-UVB); broad-band ultraviolet B (BB-UVB), which includes selective (delivering radiation with a wavelength range of 305 to 325 nm) and conventional BB-UVB (280 to 320 nm); and psoralen ultraviolet A photochemotherapy (oral or bath PUVA). There is substantial controversy regarding their efficacy when compared with each other.

Objectives: To assess the effects of narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen ultraviolet A photochemotherapy for psoriasis.

Search methods: We searched the following databases up to August 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2013, Issue 7), MEDLINE (from 1946), and EMBASE (from 1974). We searched the following databases up to November 2012: CNKI (from 1974) and CBM (from 1978). We also searched trials registers and the OpenGrey database.

Selection criteria: We included all randomised controlled trials (RCTs) that compared NB-UVB phototherapy with BB-UVB or PUVA for treating psoriasis, which included chronic plaque psoriasis (CPP), guttate psoriasis (GP), and palmoplantar psoriasis (PPP).

Data collection and analysis: Two review authors independently conducted the study selection, 'Risk of bias' assessment, and data extraction.

Main results: We included 13 RCTs, with a total of 662 participants. We report the results of intention-to-treat analyses (ITT) here. Our primary outcomes of interest were as follows: Participant-rated global improvement, Percentage of participants reaching Psoriasis Area and Severity Index (PASI) 75 (which meant equal to or more than 75% reduction in PASI score), Withdrawal due to side-effects, and Clearance rate.In one RCT of NB-UVB compared with oral PUVA in participants with CPP, the difference in PASI 75 was not statistically significant (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.63 to 1.32; N = 51; low quality). In three other RCTs of CPP, the clearance rates were inconsistent because in one, there was no difference between the groups (RR 1.01, 95% CI 0.91 to 1.12; N = 54), and in the other two, the clearance rates were statistically significantly in favour of oral PUVA: RR 0.66, 95% CI 0.47 to 0.93; N = 93 and RR 0.75, 95% CI 0.59 to 0.96; N = 100, respectively. Pooled data from these three studies indicated that withdrawals due to adverse events were not significantly different between either group (RR 0.71, 95% CI 0.20 to 2.54; N = 247; low quality).The evidence from the comparison of NB-UVB with bath PUVA in terms of clearance rate for CPP was also inconsistent: Pooled data from two left-right body comparison RCTs found no significant difference between the NB-UVB and bath PUVA groups (RR 1.79, 95% CI 0.46 to 6.91; N = 92; low quality), while a parallel RCT favoured bath PUVA (RR 0.18, 95% CI 0.05 to 0.71; N = 36; low quality).In participants with PPP, one RCT found there were no significant differences between NB-UVB treated sides and topical PUVA treated sides in terms of clearance rate (RR 0.09, 95% CI 0.01 to 1.56; N = 50; low quality).Two RCTs found NB-UVB plus retinoid (re-NB-UVB) and PUVA plus retinoid (re-PUVA) had similar effects for treating people with CPP or GP in terms of clearance rate (RR 0.93, 95% CI 0.79 to 1.10; N = 90; low quality).One RCT in people with CPP found no significant differences between NB-UVB and selective BB-UVB in terms of clearance rate (RR 1.40, 95% CI 0.92 to 2.13; N = 100; low quality) and withdrawals due to adverse events (RR 3.00, 95% CI 0.32 to 27.87; N = 100; low quality).No studies reported our primary outcomes for NB-UVB compared with conventional BB-UVB.

Authors' conclusions: Current evidence is very heterogeneous and needs to be interpreted with caution. The clearance rate between oral PUVA and NB-UVB is inconsistent among the included studies. Evidence regarding NB-UVB versus bath PUVA is also inconsistent. Re-NB-UVB and re-PUVA are similarly effective for treating people with CPP or GP. In practice, NB-UVB may be more convenient to use since exogenous photosensitiser is not required before phototherapy.NB-UVB is considered ineffective for PPP in clinical practice, and a small RCT did not detect a statistically significant difference between NB-UVB and topical PUVA for clearing PPP. NB-UVB seemed to be similar to selective BB-UVB for clearing CPP.Larger prospective studies are needed to confirm the long-term safety of NB-UVB.

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram
2
2
'Risk of bias' summary: Review authors' judgements about each 'Risk of bias' item for each included study
3
3
'Risk of bias' graph: Review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies
1.1
1.1. Analysis
Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 1 PASI 75.
1.2
1.2. Analysis
Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 2 PASI 75 (ITT analysis).
1.3
1.3. Analysis
Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 3 Withdrawals due to side‐effects.
1.4
1.4. Analysis
Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 4 Withdrawals due to side‐effects (ITT analysis).
1.5
1.5. Analysis
Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 5 Clearance rate.
1.6
1.6. Analysis
Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 6 Clearance rate (ITT analysis).
1.7
1.7. Analysis
Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 7 Clearance lasting 6 months.
1.8
1.8. Analysis
Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 8 Time to PASI 75.
1.9
1.9. Analysis
Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 9 Relapse rate at 6 months after treatment completion.
1.10
1.10. Analysis
Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 10 Withdrawals due to poor response.
1.11
1.11. Analysis
Comparison 1 NB‐UVB versus oral PUVA in CPP, Outcome 11 Adverse events.
2.1
2.1. Analysis
Comparison 2 NB‐UVB versus bath PUVA in CPP, Outcome 1 Clearance rate.
2.2
2.2. Analysis
Comparison 2 NB‐UVB versus bath PUVA in CPP, Outcome 2 Clearance rate (ITT analysis).
2.3
2.3. Analysis
Comparison 2 NB‐UVB versus bath PUVA in CPP, Outcome 3 PASI score reduction.
2.4
2.4. Analysis
Comparison 2 NB‐UVB versus bath PUVA in CPP, Outcome 4 Adverse events.
3.1
3.1. Analysis
Comparison 3 NB‐UVB versus topical PUVA in PPP, Outcome 1 Clearance rate.
3.2
3.2. Analysis
Comparison 3 NB‐UVB versus topical PUVA in PPP, Outcome 2 Clearance rate (ITT analysis).
3.3
3.3. Analysis
Comparison 3 NB‐UVB versus topical PUVA in PPP, Outcome 3 Relapse at 9 weeks after treatment completion.
3.4
3.4. Analysis
Comparison 3 NB‐UVB versus topical PUVA in PPP, Outcome 4 Marked improvement.
3.5
3.5. Analysis
Comparison 3 NB‐UVB versus topical PUVA in PPP, Outcome 5 Adverse events.
4.1
4.1. Analysis
Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 1 PASI.
4.2
4.2. Analysis
Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 2 PASI 75 (ITT analysis).
4.3
4.3. Analysis
Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 3 Clearance rate.
4.4
4.4. Analysis
Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 4 Clearance rate (ITT analysis).
4.5
4.5. Analysis
Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 5 Relapse at 6 months after treatment completion.
4.6
4.6. Analysis
Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 6 Clinical improvement.
4.7
4.7. Analysis
Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 7 Tolerability assessed as good or very good by observers (ITT analysis).
4.8
4.8. Analysis
Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 8 Tolerability assessed as good or very good by participants (ITT analysis).
4.9
4.9. Analysis
Comparison 4 NB‐UVB plus retinoid versus PUVA plus retinoid in chronic plaque or guttate psoriasis, Outcome 9 Adverse events.
5.1
5.1. Analysis
Comparison 5 NB‐UVB versus selective BB‐UVB in CPP, Outcome 1 Withdrawal due to side‐effects.
5.2
5.2. Analysis
Comparison 5 NB‐UVB versus selective BB‐UVB in CPP, Outcome 2 Withdrawals due to side‐effects (ITT analysis).
5.3
5.3. Analysis
Comparison 5 NB‐UVB versus selective BB‐UVB in CPP, Outcome 3 Clearance rate.
5.4
5.4. Analysis
Comparison 5 NB‐UVB versus selective BB‐UVB in CPP, Outcome 4 Clearance rate (ITT analysis).
5.5
5.5. Analysis
Comparison 5 NB‐UVB versus selective BB‐UVB in CPP, Outcome 5 Clearance lasting 6 months.
5.6
5.6. Analysis
Comparison 5 NB‐UVB versus selective BB‐UVB in CPP, Outcome 6 Adverse events.
6.1
6.1. Analysis
Comparison 6 NB‐UVB versus conventional BB‐UVB in different types of psoriasis, Outcome 1 Cumulative UV dose during the study.
7.1
7.1. Analysis
Comparison 7 NB‐UVB plus dithranol versus conventional BB‐UVB plus dithranol in different types of psoriasis, Outcome 1 Cumulative UV dose during the study.
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