Can Psoralen Ultraviolet-A or Narrowband Ultraviolet-B Salvage the Biologic Drug Response After a Secondary Failure? A Retrospective Cohort Study

  • B. Duarte Department of Dermatology, Hospital de Santo António dos Capuchos – Centro Hospitalar de Lisboa Central, Lisbon, Portugal
  • V. Serrão Department of Dermatology, Hospital de Santo António dos Capuchos – Centro Hospitalar de Lisboa Central, Lisbon, Portugal
  • F. Rocha Páris Department of Dermatology, Hospital de Santo António dos Capuchos – Centro Hospitalar de Lisboa Central, Lisbon, Portugal
  • G. Marques Pinto Department of Dermatology, Hospital de Santo António dos Capuchos – Centro Hospitalar de Lisboa Central, Lisbon, Portugal
  • M. Apetato Department of Dermatology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal
  • J. Cabete Department of Dermatology, Hospital de Santo António dos Capuchos – Centro Hospitalar de Lisboa Central, Lisbon, Portugal
Keywords: Photochemotherapy, Photosensitizing Agents, Psoriasis, PUVA Therapy

Abstract

Introduction: Biologic drug survival in psoriasis is mainly limited by a decrease of effectiveness over time. Strategies to improve retention rates are needed. Our purpose was to evaluate the efficacy and tolerability of concurrent narrowband ultraviolet- B (NB-UVB) or photochemotherapy (PUVA) to salvage the biologic drug in secondary non-response.

Methods: Retrospective cohort study of 18 adults with moderate-to-severe plaque psoriasis treated with biologics who received concurrent phototherapy after a secondary efficacy loss.

Results: Twelve patients underwent PUVA concurrently with etanercept and adalimumab in 13 and 5 cycles, respectively. Clinical response was observed in 72.2% of cycles (PASI75 55.5%). Median PASI decreased by 73%. Sustained response was observed for 25 months (median). A malignant melanoma was identified during follow-up. Six patients underwent NB-UVB concurrently with etanercept, adalimumab and ustekinumab in 7.3 and 2 cycles, respectively. Clinical response was observed in 75% of cycles (PASI75 41.7%). Median PASI decreased by 80%. Sustained responde was observed for 21 months (median).

Conclusions: This study adds real-life evidence that PUVA and NB-UVB are effective options to salvage and improve the long-term performance of biologic drugs. Further efficacy and safety data, especially addressing the skin malignancy risk, should be sought to clarify the role of this interesting approach in the modern era of improved biologic therapies.

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Published
2019-03-26
How to Cite
Duarte, B., Serrão, V., Rocha Páris, F., Marques Pinto, G., Apetato, M., & Cabete, J. (2019). Can Psoralen Ultraviolet-A or Narrowband Ultraviolet-B Salvage the Biologic Drug Response After a Secondary Failure? A Retrospective Cohort Study. Journal of the Portuguese Society of Dermatology and Venereology, 77(1), 33-38. https://doi.org/10.29021/spdv.77.1.1004
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Original Articles