Efficacy of psoralen UV-A therapy vs. narrowband UV-B therapy in chronic plaque psoriasis: a systematic literature review.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 22512676 · doi:10.1111/j.1468-3083.2012.04519.x
What was done
A systematic review and meta-analysis was conducted across PubMed, Cochrane, and Embase (1980–December 2010) comparing oral 8-methoxypsoralen-UV-A (PUVA) and narrowband UV-B (NB-UVB) for chronic plaque psoriasis. The review evaluated response rates (PASI-75), remission duration, and predictive efficacy factors across 29 randomized controlled trials (18 evaluating PUVA, 8 evaluating NB-UVB, and 3 head-to-head comparisons).
What was found
The PASI-75 response rate was 80% for PUVA compared to 70% for NB-UVB. Meta-analysis of the 3 direct head-to-head comparative trials showed a significantly higher probability of remission at 6 months with PUVA than with NB-UVB (OR = 2.73, 95% CI 1.19–6.27, P = 0.02). PUVA also required fewer sessions to achieve clearance (approximately 17 vs. 25 sessions). Initial dosing methods (skin type vs. minimal erythemal/phototoxic dose), dose-escalation regimens, and session frequency were not predictive factors for treatment efficacy in either group.
Why it matters
This review quantifies the efficacy advantage of PUVA over NB-UVB in clearance speed and remission longevity, aiding clinicians in balancing clinical efficacy against PUVA's greater procedural complexity and long-term cutaneous carcinogenic risks.
Limits
Direct head-to-head evidence was restricted to only three trials, and total participant counts across all 29 RCTs are not reported in the abstract. The authors noted methodological limitations in the primary trials, and safety outcomes were not quantitatively meta-analyzed.
Cited by
- supports UVB phototherapy has been demonstrated to effectively treat and clear psoriasis.