Assessment of efficacy and safety of UV-based therapy for psoriasis: a network meta-analysis of randomized controlled trials
ANNALS OF MEDICINE 022, VOL. 54, NO. 1, 159-169 https://doi.org/10.1080/07853890.2021.2022187
Yajia Lia#, Ziqin Caob#, Jia Guoa, Qiangxiang Lic'd'e, Wu Zhua,f , Yehong Kuanga,f* Xiang Chena,f*
aDepartment of Dermatology, Hunan Key Laboratory of Skin Cancer and Psoriasis; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; department of Spine Surgery, the Xiangya Hospital, Central South University, Changsha, Hunan, China; cNational Clinical Research Center for Geriatric Disorders of Xiangya hospital, Central South University (Sub-center of Ningxia), Yinchuan, Ningxia Hui Autonomous Region 750001, China; dNingxia Geriatric Disease Clinical Research Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia Hui Autonomous Region 750001, China; eHunan People's Hospital, Geriatrics Institute of Hunan Province, Changsha, China, Changsha 410002, China; fNational Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
Background: Previous studies have proven that ultraviolet (UV)-based phototherapy, including UVB or psoralen UVA (PUVA), and their combination therapies, is effective for psoriasis treatment.
Objective: To compare the clinical efficacy and adverse events (AEs) of different UV-based phototherapy in psoriasis.
Methods: PubMed, Cochrane Library, Scopus and Embase were systematically searched. A random-effect model network meta-analysis with frequentist framework was performed, and results were reported as risk ratios (RRs) with 95% CI. The main variable for assessing effectiveness and safety are PASI 75 response and withdrawal due to AEs. Ranking effects were calculated by surface under the cumulative ranking analysis (SUCRA).
Results: Thirty-two studies involving a total of 2120 psoriasis patients were included in this network meta-analysis. Overall, no significant difference was reported with respect to withdrawal due to AEs or incidence of erythema. The relatively safest strategy was combined adjuvant therapy with PUVA (cPUVA), especially PUVA combined with calcium/vitamin D derivatives (RR 0.98, 95% CI [0.30-3.17], SUCRA = 80.8%). Both cPUVA (RR 1.39, 95% CI [1.00- 1.94]) and combined adjuvant therapy with UVB (cUVB) (RR 1.27, 95% CI [1.03-1.57]) showed a superior effect than the monotherapy of UVA or UVB, respectively. PUVA combined with vitamin D and its derivatives (PAVD) ranked highest concerning clinical effect and safety (clusterank value = 7393.2).
Conclusions: The efficacy of all the combination therapy regimens was significantly superior to that of UV monotherapy, without significant differences in tolerability and safety. cUVB and cPUVA, and particularly the combination of UVA with calcium/vitamin D derivatives, was ranked as the overall safest and most effective phototherapy method.
Abbreviations: UV: Ultraviolet; PUVA: psoralen UVA; BB: broadband; NB: narrow-band; BB-UVB: Broadband UVB; NB-UVB: Narrowband UVB; RCT: randomized controlled trial; RR: risk ratio; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PASI: psoriasis area and severity index; AEs: adverse events; SUCRA: surface under the cumulative ranking; cPUVA: combined adjuvant therapy with PUVA; cAB: the combination of PUVA with UVB; PAVA: PUVA combined with vitamin A and its derivatives; PAVD: PUVA combined with vitamin D and its derivatives; UBVA: UVB combined with vitamin A and its derivatives; UBVD: UVB combined with vitamin D and its derivatives; UBST: UVB combined with systematic treatments; UBSL: UVB combined with skin lubricants; nRCTs: non-randomized control trials
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Psoriasis in VitaminDWiki
Some of the- Psoriasis is most strongly associated with low vitamin D (15 things were evaluated) – July 2022
- Long-term Psoriasis cured by 30,000 to 60,000 IU of Vitamin D daily (pictures and video) – early 2022
- Psoriasis paradigm shift – use topicals, like Vitamin D – Aug 2021
- Low Vitamin D plus psoriasis equals 8 times more likely to die – Dec 2020
- UV has treated psoriasis for over a century, guidelines finally agreed upon – Aug 2019
- Psoriasis severity associated with low vitamin D (10 studies) – meta-analysis Jan 2018
- Psoriasis reduced for those getting Vitamin D levels above 50 ng – RCT Feb 2018
- 35,000 IU vitamin D daily for 6 months helped ALL psoriasis suffers (106 ng) – Brazil March 2013
VitaminDWiki studies in both categories Psoriasis and UV (9 as of Oct 2022)
This list is automatically updated
- Best psoriasis treatment was combo of Vitamin D, UVA, and Calcium – meta-analysis Jan 2022
- UV has treated psoriasis for over a century, guidelines finally agreed upon – Aug 2019
- Ultraviolet light (which produces vitamin D) decreased the use of psoriasis drugs for a year – Aug 2017
- Phototherapy and vitamin D – Sept 2016
- Psoriasis decreased and vitamin D increased with home UV lamp – March 2015
- NB UVB increased vitamin D levels while decreasing psoriasis and CYP27A1 – March 2014
- UVB effects on genes of those with and without Psoriasis – April 2014
- Psoriasis treatment by narrowband UV B – review Nov 2010
- UV produces more than vitamin D – Aug 2011
Buried in the study: best form of Vitamin D = topical
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