Fumaric acid esters in combination with a 6-week course of narrow-band UVB provides for an accelerated response as compared to fumaric acid esters monotherapy in patients with moderate to severe plaque psoriasis: A randomized prospective clinical study

Abstract

Background

Fumaric acid esters are (FAE) safe and effective in patients with moderate to severe psoriasis but have a slow onset of action. A short-term combination with narrow-band UVB (NB UVB) may substantially accelerate the therapeutic response in the induction phase of treatment.

Objectives

To assess the synergistic effect of a 6-week course of NB UVB phototherapy in addition to fumaric acid esters in adult patients with moderate to severe plaque psoriasis.

Methods

In this randomized, assessor-blinded trial patients with a Psoriasis Area and Severity Index (PASI) of ≥10 and a body surface area (BSA) of ≥10 were randomized to either monotherapy with FAE (n=16) or a combination of FAE with NB UVB (n=14). The primary outcome parameter of the study was the mean PASI reduction after 6 weeks of treatment. In addition, the PASI 75 response, the psoriasis log-based area and severity index (PLASI) and the dermatology life quality index (DLQI) were assessed as secondary outcome measures.

Results

Thirty patients (19 males, 11 females; median age 52 years, IQR 36;56) were analysed. The mean reduction in PASI after 6 weeks was significantly greater with the combination treatment as compared to FAE monotherapy (p=0.016). This was paralleled by a much faster improvement in DLQI in the combination group than in the FAE monotherapy group.

Conclusions

Adding a 6-week course of narrow-band UVB to FAE both accelerates and augments the therapeutic response during the early phase of treatment and increases quality of life in patients with moderate-to-severe plaque psoriasis.

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