In-home phototherapy delivers promising results in psoriasis

Home-based phototherapy is equally effective as in-office treatment for plaque or guttate psoriasis regardless of skin type, providing a convenient first-line treatment option for patients, according to data from the Light Treatment Effectiveness (LITE) study.

In the primary analysis of LITE, a higher proportion of participants who underwent home- versus office-based phototherapy achieved the co-primary outcomes of complete or near-complete clearance of psoriasis lesions (physician global assessment [PGA] score 0/1; 32.8 percent vs 25.6 percent) and better health-related quality of life (Dermatology Life Quality Index [DLQI] score ≤5 [small to no effect]) at week 12, which established the noninferiority of home-based treatment (p<0.0001 for both). [Gelfand J M, et al, AAD 2024]

For the PGA score 0/1, home-based phototherapy consistently demonstrated noninferiority over office-based phototherapy across participants with skin types I/II, III/IV, and V/VI, with the largest between-group difference seen among patients with skin type V/VI (33.3 percent vs 14.6 percent; p=0.0001).

Clearly, home-based phototherapy is noninferior to office phototherapy across all skin types and for both physician- and patient-reported outcomes, said lead study investigator Dr Joel Gelfand, James J. Leyden Professor of Dermatology & Epidemiology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pennsylvania, US.

“Both home and office phototherapy have excellent effectiveness and safety in real-world settings,” Gelfand added. “These data support the use of home phototherapy as a first-line treatment option for psoriasis, including those with no prior phototherapy experience.”

Inconvenience factor

Among the numerous treatment options available for moderate-to-severe psoriasis, phototherapy stands out for its effectiveness and affordability. Gelfand pointed out that office-based phototherapy is 10 to 100 times less expensive than biologics, just as effective as adalimumab in head-to-head trials, and avoids the risk of infection seen with secukinumab.

Phototherapy may be the preferred treatment option by patients, but the inconvenience of traveling to a clinic and limited insurance coverage limit access to it, Gelfand said. In fact, office-based phototherapy is not available in 90 percent of US counties, he added, and while home-based phototherapy exists, the absence of clinical data has discouraged many insurance companies from covering home-based treatment. “As a result, many providers are uncertain about prescribing it.”

Gelfand and colleagues conducted LITE to address the lack of data. A large pragmatic randomized study embedded in routine clinical practice, LITE tested the hypothesis that narrowband UVB phototherapy for psoriasis at home is noninferior to office treatment in terms of outcomes that matter to patients, physicians, and payers. 

A total of 783 participants aged 12 years or older (mean age 48 years, 52 percent male, 7.2 percent Asian) who had plaque or guttate psoriasis (average duration 15.8 years) and skin types I-VI were enrolled across 42 sites in the US. None of them had received phototherapy in the 14 days prior to enrolment. The participants were randomly assigned to undergo office- or home-based phototherapy for 12 weeks at doses consistent with the 2019 AAD-National Psoriasis Foundation guidelines, after which the patients were followed up for another 12 weeks.

At baseline, mean DLQI was 12.2, median PGA score was 3, and mean body surface area was 12.5 percent. Roughly 12 percent of participants were on biologic or other systemic therapy, and 43 percent had prior phototherapy exposure. The participants spent an average of 60 minutes travelling round-trip for in-office phototherapy appointments, and out-of-pocket cost averaged USD 21.60.

Other outcomes

Treatment adherence was significantly higher among patients treated at home, with a mean of 26.82 in-home sessions as opposed to 17.95 in-office sessions (p<0.0001). Home-based treatment was also associated with a much higher cumulative phototherapy dose (31.43 vs 17.27 J; p<0.0001), which Gelfand noted to lead to higher episodes of treatments with erythema.

Of note, 63 percent of the participants who reported “itchy, sore, painful, or stinging” skin in the previous week characterized the degree of discomfort as “not at all or a little.”

Treatment was well tolerated, according to Gelfand, with none of the participants discontinuing phototherapy during the trial due to treatment-related side effects.

Serious adverse events were documented in four participants in the office group (breast cancer, osteosarcoma, chest pain, wound infection) and in three participants in the home group (substance abuse, neuropathy, malnutrition, COVID-related death, and hypertension).

In a news release, Gelfand described the LITE findings as “incredibly significant.”

“Health insurance companies should cover home phototherapy for treatment of psoriasis as standard of care, and dermatology providers should prescribe home phototherapy for management of psoriasis when medically appropriate and based on shared decision making with patients,” he said.