Limited treatment options are currently available for psoriasis, including topical corticosteroids, oral anti-inflammatory medications, biologic therapies, and phototherapy.¹ Phototherapy is a cost-effective alternative that has demonstrated excellent efficacy and safety, leading to better patient-reported outcomes.¹ Phototherapy also improves cardiovascular biomarkers and does not carry a risk of infection.¹ While a survey of more than 2,500 psoriasis patients and 1,000 dermatologists across the United States revealed that phototherapy remains a preferred treatment option, particularly for home phototherapy among patients, barriers such as inconvenience, accessibility, and insufficient insurance coverage hinder its use.¹

The LITE study was thus conducted to investigate whether narrowband ultraviolet B (UVB) phototherapy treatment of psoriasis at home is non-inferior to office treatment according to outcomes that matter to patients, providers, and payers.¹ The entry criteria were designed to reflect clinical practice, hence patients aged ≥12 years with plaque or guttate psoriasis who were candidates for phototherapy at home or office were eligible.¹ Patients who had received phototherapy treatment 14 days prior to baseline visit were excluded.¹ Patients were randomized 1:1 to receive office-based or home-based phototherapy for 12 weeks, followed by an observational period of 12 weeks.¹ The co-primary outcomes of the trial were physician global assessment (PGA) dichotomized as 0/1 (clear/almost clear) and the Dermatology Life Quality Index (DLQI) dichotomized as ≤5 (small to no effect on health-related quality of life).¹ A non-inferiority margin of 15% was set based on biosimilar studies.¹

A total of 783 patients participated in the trial with a mean age of 48.0 years, of which 350 (44.7%) had skin phototype (SPT) I/II, 350 (44.7%) had SPT III/IV, and 83 (10.6%) had SPT V/VI.¹ The mean BMI of patients was 29.6kg/m² and 58% of patients had a history of cardiometabolic disease.¹ At baseline, these patients had a median PGA score of 3 and a mean DLQI score of 12.2.¹ These patients also experienced considerable travel times to access phototherapy (mean estimated travel time=59 minutes) and were required to share in the treatment costs through co-payment.¹ 11.9% of patients were currently receiving biologics or non-biological systemic therapy.¹

At the end of 12 weeks, 129 patients (32.8%) who received home phototherapy and 100 patients (25.6%) who received office phototherapy achieved clear/almost clear skin (PGA 0/1), translating to a 7.2% (95% CI: 0.8-13.5) response difference (p_{non-inferiority} <0.0001).¹ The greatest difference between groups was seen for patients with SPT V/VI, with 33.3% in the home group achieving PGA 0/1 compared with 14.6% in the office group (response difference=18.7%; 95% CI: 0.8-36.6; p_{non-inferiority}=0.0001).¹ More patients in the home group also achieved a DLQI score ≤5 compared to those in the office group (52.4% vs. 33.6%; response difference=18.6%; 95% CI: 11.8-25.3; p_{non-inferiority}<0.0001) and the results were similar across skin phototypes.¹ Sensitivity analyses evaluating varying approaches to missing data, adherence to treatment, and restricting to patients with no previous phototherapy yielded similar results to the primary analysis.¹

Secondary outcomes which favored home phototherapy over office phototherapy included the number of days per week a patient used topical concomitant psoriasis treatments (mean days for home vs. office=3.06 vs. 3.92, p=0.001), number of patients who achieved a minimally clinically important difference in DLQI of ≥4 (47.84% vs. 33.33%, p<0.001), achieved a DLQI of 0/1 at week 12 (25.45% vs. 13.33%), and achieved a 75% (35.62% vs. 24.19%, p<0.001) and 90% reduction (25.70% vs. 17.44%, p=0.005) in body surface area (BSA) x PGA score.¹ The mean duration of treatment response after week 12 was 77.32 days in the home group and 74.24 days in the office group (p=0.18).¹

Adherence to treatment was better among patients who received home phototherapy, with 51.40% receiving ≥24 treatments across the 12 weeks compared with 15.90% of patients who received office-based phototherapy (p<0.0001).¹ The mean number of treatments for the home group was 26.82 and 17.95 for the office group (p<0.0001).¹ The mean dose of treatment received was 1.17 joules and 9.86 joules for the home and office groups respectively (p<0.0001).¹ Although, patients in the home group had slightly more frequent episodes of persistent erythema >48 hours after treatment than those in the office group (5.86% vs 1.17%, p<0.0001), no serious adverse events related to treatment were reported.¹

In conclusion, home phototherapy was shown to be non-inferior to office phototherapy across all skin types and for both patient-reported (DLQI) and physician-assessed (PGA) outcomes.¹ These data support the use of home therapy as a first-line treatment option for psoriasis, including those with no prior phototherapy experience.¹ Given the demonstrated real-world effectiveness and safety of both home and office phototherapy, more efforts to improve patient access to these treatments were couraged.¹