Comparison of Narrowband UV-B With Psoralen–UV-A Phototherapy for Patients With Early-Stage Mycosis Fungoides

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Original Investigation

January 30, 2019

Comparison of Narrowband UV-B With Psoralen–UV-A Phototherapy for Patients With Early-Stage Mycosis FungoidesA Systematic Review and Meta-analysis

Kevin Phan, MD^1,2; Vignesh Ramachandran, BS³; Hiva Fassihi, MD, FRCP⁴; et alDeshan F. Sebaratnam, MBBS (Hons), MMed, FACD^1,2

Author Affiliations

JAMA Dermatol. Published online January 30, 2019. doi:10.1001/jamadermatol.2018.5204

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Key Points

Question  How does the efficacy of narrowband UV-B compare with that of psoralen–UV-A for early-stage mycosis fungoides?

Findings  In this systematic review and meta-analysis of 7 studies with 778 patients with early-stage mycosis fungoides, response rates to narrowband UV-B were similar to those for psoralen–UV-A. No significant difference was found between narrowband UV-B and psoralen–UV-A in terms of adverse effects.

Meaning  The findings suggest that narrowband UV-B is a viable and safe alternative to psoralen–UV-A for treatment of early-stage mycosis fungoides.

Abstract

Importance  Phototherapy is one of the mainstays of treatment for early mycosis fungoides (MF). The most common modalities are psoralen–UV-A (PUVA) and narrowband UV-B (NBUVB).

Objective  To compare the efficacy and adverse effects of PUVA vs NBUVB in early-stage MF.

Data Sources  A systematic review was performed by searching Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Ovid Medline, PubMed, Cochrane Library, American College of Physicians ACP Journal Club, and Database of Abstracts of Review of Effectiveness from inception to March 30, 2018. UV A, PUVA, mycosis fungoides, Sézary syndrome, cutaneous T-cell lymphoma, UV B, and UVB were used as either key words or MeSH terms.

Study Selection  Studies of cohorts with histologically confirmed early-stage MF, defined as stages IA, IB, and IIA, that compared PUVA vs NBUVB, had at least 10 patients in each comparator group, and reported outcomes of response to therapy. Exclusion criteria were studies with patients with stage IIB or higher MF, pediatric patients, fewer than 10 in each comparator group, noncomparative studies, case reports, and abstract studies.

Data Extraction and Synthesis  The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Data were pooled using a random-effects model with odds ratio (OR) as effect size.

Main Outcomes and Measures  Main outcomes were complete response rate, partial response rate, disease recurrence, and adverse effects, including erythema, nausea, pruritus, phototoxic effects, dyspepsia, and pain.

Results  Seven studies were included with a total of 778 patients (405 of 724 [55.9%] men; mean age, 52 years); 527 were treated with PUVA and 251 with NBUVB. Most of the included studies were of poor to moderate quality. Any response was found in 479 of the 527 (90.9%) patients treated with PUVA vs 220 of 251 (87.6%) treated with NBUVB (OR, 1.40; 95% CI, 0.84-2.34; P = .20). Complete response was found in 389 of 527 (73.8%) patients who received PUVA vs 156 of 251 (62.2%) who received NBUVB, which was statistically significant (OR, 1.68; 95% CI, 1.02-2.76; P = .04). Partial response was similar (90 of 501 [18.0%] vs 64 of 233 [27.5%]; OR, 0.58; 95% CI, 0.33-1.04; P = .07). No significant difference was found between PUVA and NBUVB in terms of adverse effects of erythema (38 of 527 [7.2%] vs 17 of 251 [6.7%]; P = .54), nausea (10 of 527 [1.9%] vs 3 of 251 [1.2%]; P = .72), pruritus (2 of 527 [0.4%] vs 4 of 251 [1.7%]; P = .26), phototoxic effects (7 of 527 [1.4%] vs 2 of 251 [0.9%]; P = .72), dyspepsia (6 of 527 [1.2%] vs 0 of 251 [0%]; P = .59), or pain (0 of 527 [0%] vs 2 of 251 [0.9%]; P = .50).

Conclusions and Relevance  The findings suggest that PUVA is a potential alternative to NBUVB in the management of early-stage MF. These findings have implications for clinicians involved in the management of early-stage MF.

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