基于紫外线的银屑病治疗的系统评价。
Systematic review of UV-based therapy for psoriasis.
机构信息
Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
出版信息
Am J Clin Dermatol. 2013 Apr;14(2):87-109. doi: 10.1007/s40257-013-0015-y.
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.
AIM
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.
背景
紫外线疗法，包括窄谱（NB）UVB、宽谱（BB）UVB 和补骨脂素加 UVA（PUVA），是治疗中度至重度斑块型银屑病的常用方法。然而，关于其疗效、短期安全性和耐受性的循证综述有限。
目的
本研究旨在评估紫外线疗法在治疗中重度斑块型银屑病成人患者中的疗效、短期安全性和耐受性。
方法
我们对评估 NB-UVB、BB-UVB 和 PUVA 治疗中度至重度斑块型银屑病成人的随机对照试验（RCT）进行了系统评价和荟萃分析。我们的疗效终点为 PASI-75 缓解和清除。我们分别从不良反应的百分比和因不良反应退出的比例评估短期安全性和耐受性。
结果
共有 41 项 RCT，共计 2416 名患者符合纳入标准并纳入分析。在单药治疗试验中，PASI-75 缓解方面，PUVA（平均：73%，95%CI 56-88）是最有效的治疗方法。BB-UVB 试验也显示出较高的 PASI-75（73%），但由于总共有三项研究存在异质性，CI 较宽（18-98）。其次是 NB-UVB（平均：62%，95%CI 45-79），然后是沐浴 PUVA（平均：47%，95%CI 30-65）。在单药治疗试验中，清除方面，PUVA（平均：79%，95%CI 69-88）优于 NB-UVB（平均：68%，95%CI 57-78）、BB-UVB（平均：59%，95%CI 44-72）和沐浴 PUVA（平均：58%，95%CI 44-72）。单药治疗试验中无症状红斑发展的百分比分别为：BB-UVB 为 64%，NB-UVB 为 57%，PUVA 为 45%，沐浴 PUVA 为 34%。单药治疗试验中出现症状性红斑或水疱的百分比分别为：NB-UVB 为 7.8%，BB-UVB 为 2%，PUVA 为 17%，沐浴 PUVA 为 21%。因不良反应退出的百分比分别为：NB-UVB 为 2%，BB-UVB 为 4.6%，PUVA 为 5%，沐浴 PUVA 为 0.7%。
结论
作为单一疗法，PUVA 比 NB-UVB 更有效，NB-UVB 比 BB-UVB 和沐浴 PUVA 更有效，基于清除作为终点。基于 PASI-75，结果相似，除 BB-UVB 外，BB-UVB 显示出较高的平均 PASI-75（73%），与 PUVA 相似，但 CI 较宽（18-98）。短期不良反应轻微，因不良反应退出的比例较低。
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