By David Douglas
NEW YORK (Reuters Health) - Narrowband UV-B phototherapy (UVB) appears to be almost as effective as psoralen-UV-A (PUVA) phototherapy for treating early-stage mycosis fungoides, according to pooled observational data.
As Dr. Deshan F. Sebaratnam of Liverpool Hospital, in Sydney, Australia, told Reuters Health by email, "Narrowband UVB is a safe and effective alternative to PUVA treatment in early mycosis fungoides."
Both treatments are widely used but comparisons are limited, Dr. Sebaratnam and colleagues note in JAMA Dermatology, online January 30.
To investigate, the team conducted a systematic review and meta-analysis of comparative research. They identified seven observational studies, all but one of which were retrospective and of "poor to moderate quality."
The studies involved 527 patients treated with PUVA and 251 who receive UVB. Complete response was achieved in 73.8% of the PUVA patients, significantly more than the 62.2% seen with UVB. The rate of partial response was 18.0% and 27.5%, respectively (P=0.07).
There were no significant differences in terms of adverse effects such as erythema, nausea, pruritus or phototoxic effects.
When data from two relevant studies were pooled, PUVA was associated with a significantly higher chance of freedom from recurrence compared with UVB (hazard ratio, 1.93). The median relapse-free interval with PUVA was 33.4 weeks compared to 14.9 weeks for UVB.
"Pooled analysis does not account for differences in patient compliance to therapy, as well as baseline differences in patient characteristics including age, sex, comorbidities, and duration of disease before diagnosis and treatment," the researchers caution.
Dr. Sebaratnam concluded, "Mycosis fungoides is a condition that cannot be cured. Accordingly treatment should be centered around optimising quality of life. Narrowband UVB is an effective treatment with a favourable side effect profile."
Dr. Steven C. Chen, co-director of the Comprehensive Cutaneous Lymphoma Program at Massachusetts General Hospital, in Boston, told Reuters Health by email, "As the authors themselves point out, the heterogeneity of studies and methods, as well as the low number of included articles, limits this article’s ability to make suggestions for sweeping change to early mycosis fungoides therapy."
"While the meta-analysis suggests that there is an increased complete response rate with PUVA when compared to UVB, the effect size is small to modest, and the overall response rate is not much different between the groups," he added.
Thus, Dr. Chen said, "I will likely not be changing the way I counsel my patients about these therapeutic modalities." However, he noted, the study "does serve as a good reminder that phototherapy is an effective and well tolerated treatment for some of our early-stage mycosis fungoides patients and should be considered in the right setting and person. The use of phototherapy still requires counseling about potential side effects and setting realistic expectations."
JAMA Dermatol 2019.