Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, Australia.
South Western Sydney Clinical School, University of New South Wales, Kensington, Sydney, Australia.
JAMA Dermatol. 2019 Mar 1;155(3):335-341. doi: 10.1001/jamadermatol.2018.5204.
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).
To compare the efficacy and adverse effects of PUVA vs NBUVB in early-stage MF.
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.
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.
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 were complete response rate, partial response rate, disease recurrence, and adverse effects, including erythema, nausea, pruritus, phototoxic effects, dyspepsia, and pain.
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).
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.
光化学疗法是治疗蕈样肉芽肿（MF）早期的主要方法之一。最常见的方法是补骨脂素-长波紫外线（PUVA）和窄谱中波紫外线（NBUVB）。
比较 PUVA 与 NBUVB 在早期 MF 中的疗效和不良反应。
通过检索 Cochrane 系统评价数据库、Cochrane 对照试验中心注册库、Ovid Medline、PubMed、Cochrane 图书馆、美国医师学院 ACP 期刊俱乐部和从成立到 2018 年 3 月 30 日的疗效摘要数据库，进行了系统评价。使用关键词或 MeSH 术语作为 UV A、PUVA、蕈样肉芽肿、Sézary 综合征、皮肤 T 细胞淋巴瘤、UV B 和 UVB。
研究队列包括组织学证实的早期 MF，定义为 IA、IB 和 IIA 期，比较 PUVA 与 NBUVB，每个对照组至少有 10 例患者，并且报告了治疗反应的结果。排除标准为：MF 期 IIB 或更高、儿科患者、每个对照组少于 10 例、非对照研究、病例报告和摘要研究。
遵循系统评价和荟萃分析的首选报告项目（PRISMA）报告准则。使用随机效应模型，以比值比（OR）作为效应大小，对数据进行汇总。
主要结果是完全缓解率、部分缓解率、疾病复发和不良反应，包括红斑、恶心、瘙痒、光毒性作用、消化不良和疼痛。
纳入了 7 项研究，共 778 例患者（男性 405/724 [55.9%]；平均年龄 52 岁）；527 例患者接受 PUVA 治疗，251 例患者接受 NBUVB 治疗。纳入的大多数研究质量较差或中等。接受 PUVA 治疗的 527 例患者中，479 例（90.9%）出现任何反应，接受 NBUVB 治疗的 251 例患者中，220 例（87.6%）出现反应（OR，1.40；95%CI，0.84-2.34；P=0.20）。接受 PUVA 治疗的 527 例患者中，389 例（73.8%）完全缓解，而接受 NBUVB 治疗的 251 例患者中，156 例（62.2%）完全缓解，差异有统计学意义（OR，1.68；95%CI，1.02-2.76；P=0.04）。部分缓解也相似（接受 501 例 PUVA 治疗的患者中有 90 例[18.0%]，接受 233 例 NBUVB 治疗的患者中有 64 例[27.5%]；OR，0.58；95%CI，0.33-1.04；P=0.07）。在不良反应方面，PUVA 与 NBUVB 之间无显著差异，包括红斑（接受 527 例 PUVA 治疗的患者中有 38 例[7.2%]，接受 251 例 NBUVB 治疗的患者中有 17 例[6.7%]；P=0.54）、恶心（接受 527 例 PUVA 治疗的患者中有 10 例[1.9%]，接受 251 例 NBUVB 治疗的患者中有 3 例[1.2%]；P=0.72）、瘙痒（接受 527 例 PUVA 治疗的患者中有 2 例[0.4%]，接受 251 例 NBUVB 治疗的患者中有 4 例[1.7%]；P=0.26）、光毒性作用（接受 527 例 PUVA 治疗的患者中有 7 例[1.4%]，接受 251 例 NBUVB 治疗的患者中有 2 例[0.9%]；P=0.72）、消化不良（接受 527 例 PUVA 治疗的患者中有 6 例[1.2%]，接受 251 例 NBUVB 治疗的患者中无患者出现；P=0.59）或疼痛（接受 527 例 PUVA 治疗的患者中无患者出现，接受 251 例 NBUVB 治疗的患者中有 2 例[0.9%]；P=0.50）。
研究结果表明，PUVA 可能是治疗早期 MF 的 NBUVB 的替代方法。这些发现对参与早期 MF 管理的临床医生具有重要意义。
