Findings Demonstrate that Home Phototherapy is Non-Inferior to Office Phototherapy, with Excellent Effectiveness and Safety in Real World Settings
ALEXANDRIA, VA, UNITED STATES – September 26, 2024
New research published yesterday in JAMA Dermatology demonstrates that home-based phototherapy is as effective as office-based phototherapy for the treatment of psoriasis. Findings support the use of home phototherapy as a first-line treatment option for psoriasis, including individuals with no prior phototherapy experience, while also advocating to make phototherapy more available to people living with psoriasis.
Phototherapy involves exposing the skin to narrowband ultraviolet B (nbUVB) for the treatment of psoriasis and remains a viable treatment option for patients. Office-based phototherapy is cost-effective for psoriasis but can be difficult to access. Major barriers affect a patient’s ability to access phototherapy in a dermatologist’s office, including limited geographic availability, the inconvenience of attending regular appointments for treatment, and high copays. While home phototherapy is preferred by patients, there is limited clinical data, particularly in darker skin patients, to show its effectiveness. This has resulted in health insurance companies being less likely to cover home-based phototherapy, and health care providers may be uncertain about prescribing it.
Launched in 2019, the Light Treatment Effectiveness (LITE) study was designed to address this gap. The LITE study is a large pragmatic randomized study embedded in routine clinical practice that compared the effectiveness, safety (tolerability), and duration of treatment response at 12 weeks of home versus office-based nbUVB phototherapy for the treatment of plaque or guttate psoriasis across all skin types.
In the study, 783 participants with plaque or guttate psoriasis were randomized to receive a home nbUVB machine with guided mode dosimetry (n=393) or routine care with office-based nbUVB (n=390) for 12 weeks, followed by an additional 12-week observation period. The study was embedded at in routine care at 42 academic and private clinical dermatology practices in the United States, and patients with all skin tones were included.
Ultimately, findings demonstrated that home phototherapy is as effective as office phototherapy for plaque or guttate psoriasis in real-world clinical practice and has less burden on patients. At week 12, 33% of home and 26% of office patients achieved clear/almost clear skin and 54% and 34% achieved DLQI ≤5 (no to mild impact on health-related quality of life), respectively. Home phototherapy was non-inferior to office phototherapy for PGA and Dermatology Life Quality Index (DLQI) for all skin types (p<.001). Home phototherapy was associated with better treatment adherence (51% vs. 16%, p <.001), lower burden of indirect costs to patients, and more episodes of persistent erythema (5.9% vs. 1.2%, p<.001). Both treatments were well tolerated with no discontinuations due to adverse events.
“The LITE study provides compelling evidence that home phototherapy is just as safe and effective as office phototherapy for psoriasis in patients with a variety of skin tones,” said Joel M. Gelfand, M.D., M.S.C.E, principal investigator, and James J. Leyden Professor of Dermatology & Epidemiology at the Perelman School of Medicine at the University of Pennsylvania. “Efforts should be made to make these safe, effective, and relatively inexpensive treatment options more available to patients in the modern era of psoriasis therapeutics. Health insurance companies should cover home phototherapy for treatment of psoriasis as standard of care, and dermatology providers should prescribe home phototherapy for management of psoriasis when medically appropriate and based on shared decision making with patients.”
The LITE study is the result of a collaboration between the National Psoriasis Foundation (NPF), the University of Pennsylvania Perelman School of Medicine, and the University of Utah. It was funded by the Patient-Centered Outcomes Research Institute (PCORI), an independent research institute authorized by Congress in 2010 that funds comparative clinical effectiveness research that engages patients and other stakeholders throughout the research process.
“The data generated in the LITE study pave the way for new policies that improve access to care for phototherapy,” said Kristina Callis Duffin, M.D., co-principal investigator, and Professor and Chair of Dermatology at the Spencer Fox Eccles School of Medicine at the University of Utah. “Any patient, no matter where they live, should be able to access phototherapy for psoriasis when necessary.”
“Findings from the LITE study strongly support the need for elimination of copays for phototherapy delivered in the office and the need for better coverage of home phototherapy to improve health outcomes for all people living with psoriasis,” said Leah M. Howard, J.D., President and CEO of NPF. “We urge health insurance companies to make phototherapy more available to people living with psoriasis, as we work to help our community find effective treatment options.”
“It is so exciting that this data is being published, informing both health care providers and health insurers about this important, effective, and convenient treatment option,” said Alisha Bridges, a member of the LITE study patient engagement committee “We need more dermatologists to prescribe home phototherapy and need insurers to expand access so that more patients like me can access this treatment.”
About the National Psoriasis Foundation
Serving the community of people impacted by psoriatic disease for more than 55 years with patient support, advocacy, research, and education, the National Psoriasis Foundation is the leading nonprofit representing individuals with psoriasis and psoriatic arthritis. The mission of NPF is to drive efforts to cure psoriatic disease and improve the lives of more than 8 million individuals in the United States affected by this chronic immune-mediated disease. Learn more at psoriasis.org.