title: Systematic review of UV-based therapy for psoriasis.
abstract: BACKGROUND
  UV-based therapies, which include narrow-band (NB) UVB, broad-band (BB) UVB, and psoralen and UVA (PUVA), are well known treatment options for moderate to severe plaque psoriasis. However, there are limited evidence-based reviews on their efficacy, short-term safety, and tolerability.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the efficacy, short-term safety, and tolerability of UV-based therapy in the treatment of adults with moderate to severe plaque psoriasis.
  
  
  METHODS
  We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating NB-UVB, BB-UVB, and PUVA in adults with moderate to severe plaque-type psoriasis. Our efficacy outcomes were ≥ Psoriasis Area and Severity Index (PASI)-75 and clearance. We evaluated the short-term safety and tolerability from the percentage of adverse effects and withdrawal due to adverse effects, respectively.
  
  
  RESULTS
  Forty-one RCTs, with a total of 2,416 patients, met the eligibility criteria and were included in the analysis. In regard to PASI-75 in monotherapy trials, PUVA (mean: 73 %, 95 % CI 56-88) was the most effective modality. Trials with BB-UVB also showed a high PASI-75 (73 %) but with a wide CI (18-98) due to heterogeneity of the total available three studies. This was followed by NB-UVB (mean: 62 %, 95 % CI 45-79) then bath PUVA (mean: 47 %, 95 % CI 30-65). In regard to clearance in the monotherapy trials, PUVA (mean: 79 %, 95 % CI 69-88) was superior to NB-UVB (mean: 68 %, 95 % CI 57-78), BB-UVB (mean: 59 %, 95 % CI 44-72), and bath PUVA (mean: 58 %, 95 % CI 44-72). The percentages of asymptomatic erythema development in monotherapy trials were 64 % for BB-UVB, 57 % for NB-UVB, 45 % for PUVA, and 34 % for bath PUVA. Symptomatic erythema or blistering percentages for the monotherapy trials were as follows: 7.8 % for NB-UVB, 2 % for BB-UVB, 17 % for PUVA, and 21 % for bath PUVA. The percentages of withdrawal due to adverse effects were 2 % for NB-UVB, 4.6 % for BB-UVB, 5 % for PUVA, and 0.7 % for bath PUVA monotherapy trials.
  
  
  CONCLUSIONS
  As a monotherapy, PUVA was more effective than NB-UVB, and NB-UVB was more effective than BB-UVB and bath PUVA in the treatment of adults with moderate to severe plaque-type psoriasis, based on clearance as an end point. Based on PASI-75, the results were similar except for BB-UVB, which showed a high mean PASI-75 (73 %) that was similar to PUVA, but with a wide CI (18-98). The short-term adverse effects were mild as shown by the low rate of withdrawal due to adverse effects.
authors.affiliation: Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
authors.forename: Fahad
authors.initials: F
authors.lastname: Almutawa
authors.forename: Naif
authors.initials: N
authors.lastname: Alnomair
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.forename: Iltefat
authors.initials: I
authors.lastname: Hamzavi
authors.forename: Henry W
authors.initials: HW
authors.lastname: Lim
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D011564:Furocoumarins / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011701:PUVA Therapy / Q000379:methods; D010349:Patient Compliance / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011565:Psoriasis / Q000175:diagnosis* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods*
chemical_list: D011564:Furocoumarins