Narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen-ultraviolet A photochemotherapy for psoriasis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 24151011 · doi:10.1002/14651858.CD009481.pub2
What was done
This Cochrane systematic review evaluated randomized controlled trials (RCTs) comparing narrow-band ultraviolet B (NB-UVB) phototherapy against broad-band ultraviolet B (BB-UVB) or psoralen-ultraviolet A photochemotherapy (PUVA; oral, bath, or topical) for chronic plaque psoriasis (CPP), guttate psoriasis (GP), or palmoplantar psoriasis (PPP). Two independent authors searched multiple databases through August 2013 and assessed risk of bias. Primary outcomes were participant-rated global improvement, PASI 75 response, withdrawal due to adverse events, and clearance rate, analyzed by intention-to-treat.
What was found
Thirteen RCTs (662 participants) were included. For CPP, one trial found no significant difference between NB-UVB and oral PUVA for PASI 75 (risk ratio [RR] 0.91, 95% CI 0.63 to 1.32; n=51; low quality). Clearance rates for oral PUVA versus NB-UVB were inconsistent: one RCT showed no difference (RR 1.01, 95% CI 0.91 to 1.12; n=54), while two favoured 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). Adverse event withdrawals between oral PUVA and NB-UVB did not differ significantly (pooled RR 0.71, 95% CI 0.20 to 2.54; 3 RCTs, n=247). For bath PUVA in CPP, two intra-individual trials found no difference (RR 1.79, 95% CI 0.46 to 6.91; n=92), while one parallel trial favoured bath PUVA (RR 0.18, 95% CI 0.05 to 0.71; n=36). Retinoid-augmented NB-UVB and PUVA showed similar clearance for CPP/GP (RR 0.93, 95% CI 0.79 to 1.10; 2 RCTs, n=90). Clearance between NB-UVB and selective BB-UVB was not significantly different (RR 1.40, 95% CI 0.92 to 2.13; 1 RCT, n=100). No trials reported primary outcomes for NB-UVB versus conventional BB-UVB.
Why it matters
NB-UVB is widely preferred in clinical practice due to convenience and lack of photosensitizer requirements, but evidence establishing its relative efficacy compared to PUVA remains weak and heterogeneous.
Limits
The evidence base is small (662 participants across 13 trials) and all comparisons were graded low quality. Studies showed marked heterogeneity, wide confidence intervals, and inconsistent outcome definitions. Long-term safety was unassessed, and data comparing NB-UVB to conventional BB-UVB were absent.
Cited by
- supports UVB phototherapy has been demonstrated to effectively treat and clear psoriasis.