A large randomized clinical trial found that home-based narrowband UV-B phototherapy may be noninferior to office-based treatment in patients with plaque or guttate psoriasis across all skin types. The study also demonstrated that home-based treatment was potentially associated with better adherence and lower burden among patients.

In the pragmatic, open-label, parallel-group, multicenter Light Treatment Effectiveness trial, published in JAMA Dermatology, researchers enrolled 783 patients aged 12 years and older with plaque or guttate psoriasis from 42 dermatology practices in the United States. The participants were randomly assigned to receive either home-based narrowband UV-B phototherapy (n = 393) or office-based treatment (n = 390) for 12 weeks, followed by a 12-week observation period.

The study population had a mean age of 48.0 years, with 48.0% being female. Skin phototypes were distributed as follows: 44.7% SPT I/II, 44.7% SPT III/IV, and 10.6% SPT V/VI. Patients had a mean psoriasis duration of 15.8 years (standard deviation [SD] = 14.8), and 39.9% had previously received biologic or nonbiologic systemic therapy. At baseline, the mean PGA was 2.7, mean DLQI was 12.2, and mean body surface area (BSA) affected was 12.5% (SD = 15.7%).

Comorbidities were common among the participants, with 58.0% having cardiometabolic disease, 17.0% with psoriatic arthritis, and 14.3% with mood disorder or anxiety. The median distance from the dermatology office was 20 miles (interquartile range [IQR] = 9–40), and the mean copayment for office-based phototherapy was $17.50 (SD = $30.40) per treatment. Estimated travel costs for office-based patients were approximately $19.90 per treatment, adding up to around $720 for a 12-week treatment course.

At week 12, 32.8% of the patients in the home-based group achieved clear/almost clear skin (Physician Global Assessment [PGA] score ≤ 1) compared with 25.6% in the office-based group. Additionally, 52.4% of home-based patients achieved a Dermatology Life Quality Index (DLQI) score of 5 or lower (no to small effect on quality of life) vs 33.6% of office-based patients. Home-based phototherapy was noninferior to office-based treatment for both PGA and DLQI outcomes across all skin phototypes (SPTs I/II, III/IV, and V/VI).

Further, the patients in the home-based group were more likely to adhere to treatment, with 51.4% receiving at least 24 treatments compared with 15.9% in the office-based group (P < .001). Both treatments were well-tolerated, with no discontinuations related to adverse events. However, the home-based group experienced more episodes of persistent erythema (5.9% vs 1.2% of treatments, P < .001).

Treatment details revealed that home-based patients started treatment on average 8 days later than office-based patients. The mean number of treatments was 26.8 (SD = 10.6) for home-based vs 18.0 (SD = 8.8) for office-based, with mean cumulative doses of 31.4 J (SD = 29.6) and 17.3 J (SD = 16.1), respectively.

Additional efficacy outcomes favored home-based treatment. More patients in the home-based group achieved a DLQI of 0/1 (25.5% vs 13.3%, difference = 12.0 percentage points, 95% confidence interval [CI] = 6.5–17.4, P < .001) and a 90% reduction in BSA × PGA (25.7% vs 17.4%, difference = 8.2 percentage points, 95% CI = 2.5–13.9, P = .005). The duration of treatment response after week 12 was similar between groups (mean 77.3 days, SD = 17.0 for home-based vs 74.2 days, SD = 19.0 for office-based).

Safety data showed 5 serious adverse events in 3 patients (0.8%) in the home-based group and 4 events in 4 patients (1.0%) in the office-based group. In 62.5% of treatments associated with persistent erythema, patients reported "no" or only "a little itchy, sore, painful, or stinging skin."

Economic considerations revealed that office-based patients spent a mean of 50.3 minutes (SD = 46.7) traveling to and from each treatment. In 2024, Medicare covered the home phototherapy device at $6040.88, although the actual cost to patients varied based on their insurance plans.

Sensitivity analyses showed consistent results when using different approaches to missing data. However, noninferiority for PGA of clear/almost clear was not demonstrated in the subgroup of patients who received at least 24 treatments because of low adherence in the office-based group.

The study had some limitations, including missing outcome data and potential underestimation of the costs associated with office-based treatment as a result of selection bias.

Conflict of interest disclosures can be found in the study.